Provider Demographics
NPI:1790029445
Name:RICHARD VERDERAME DDS MS LLC
Entity type:Organization
Organization Name:RICHARD VERDERAME DDS MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDERAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-891-3000
Mailing Address - Street 1:4111 BARBARA LOOP SE
Mailing Address - Street 2:E-2
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1068
Mailing Address - Country:US
Mailing Address - Phone:505-891-3000
Mailing Address - Fax:505-891-7880
Practice Address - Street 1:4111 BARBARA LOOP SE
Practice Address - Street 2:E-2
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1068
Practice Address - Country:US
Practice Address - Phone:505-891-3000
Practice Address - Fax:505-891-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty