Provider Demographics
NPI:1801806245
Name:SERCHUK, RICHARD BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRUCE
Last Name:SERCHUK
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 1:5 VALENTINES LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2525
Mailing Address - Country:US
Mailing Address - Phone:516-759-1310
Mailing Address - Fax:516-759-1301
Practice Address - Street 1:5 VALENTINES LN
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-2525
Practice Address - Country:US
Practice Address - Phone:516-759-1310
Practice Address - Fax:516-759-1301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY0370901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice