Provider Demographics
NPI:1750375317
Name:MORI, RICHARD J (DMD LLC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:MORI
Suffix:
Gender:M
Credentials:DMD LLC
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Mailing Address - Street 1:1580 SCOTTSGATE CT N
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-8514
Mailing Address - Country:US
Mailing Address - Phone:937-320-1504
Mailing Address - Fax:937-254-5071
Practice Address - Street 1:4440 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3031
Practice Address - Country:US
Practice Address - Phone:937-252-9564
Practice Address - Fax:937-254-5071
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH30-02-10651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics