Provider Demographics
NPI:1801962030
Name:GARDEN, RICHARD BRIAN (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRIAN
Last Name:GARDEN
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 1:555 BENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2523
Mailing Address - Country:US
Mailing Address - Phone:410-647-0079
Mailing Address - Fax:410-647-7405
Practice Address - Street 1:555 BENFIELD RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2523
Practice Address - Country:US
Practice Address - Phone:410-647-0079
Practice Address - Fax:410-647-7405
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD098921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV225Medicare ID - Type Unspecified
MDT86725Medicare UPIN