Provider Demographics
NPI:1750417226
Name:TEETS, RICHARD W (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:TEETS
Suffix:
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 1:2500 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-992-3711
Mailing Address - Fax:770-992-5812
Practice Address - Street 1:2500 OLD ALABAMA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-992-3711
Practice Address - Fax:770-992-5812
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA7978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist