Provider Demographics
NPI:1669560967
Name:MAINS, RICHARD WESLEY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WESLEY
Last Name:MAINS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PANORAMA TRL
Mailing Address - Street 2:BLDG 2; SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2404
Mailing Address - Country:US
Mailing Address - Phone:585-586-6670
Mailing Address - Fax:585-586-6701
Practice Address - Street 1:625 PANORAMA TRL
Practice Address - Street 2:BLDG 2; SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2404
Practice Address - Country:US
Practice Address - Phone:585-586-6670
Practice Address - Fax:585-586-6701
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice