Provider Demographics
NPI:1811938004
Name:RICHARD, MICHAEL WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:RICHARD
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 1:2702 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3670
Mailing Address - Country:US
Mailing Address - Phone:620-271-7474
Mailing Address - Fax:620-275-1190
Practice Address - Street 1:2702 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3670
Practice Address - Country:US
Practice Address - Phone:620-271-7474
Practice Address - Fax:620-275-1190
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice