Provider Demographics
NPI:1740260405
Name:THOUIN, RICHARD JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:THOUIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 756
Mailing Address - Street 2:209 MCLEAN AVE
Mailing Address - City:COLERAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55722-0756
Mailing Address - Country:US
Mailing Address - Phone:218-245-1278
Mailing Address - Fax:218-245-1333
Practice Address - Street 1:209 MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:COLERAINE
Practice Address - State:MN
Practice Address - Zip Code:55722-0756
Practice Address - Country:US
Practice Address - Phone:218-245-1278
Practice Address - Fax:218-245-1333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00514039OtherUNITED CONCORDIA
MN73440THOtherBLUE CROSS BLUE SHIELD
T66219Medicare UPIN