Provider Demographics
NPI:1881708840
Name:RYDMAN, RICHARD A (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:RYDMAN
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:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-0470
Mailing Address - Country:US
Mailing Address - Phone:509-488-2651
Mailing Address - Fax:509-488-3243
Practice Address - Street 1:425 E HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1449
Practice Address - Country:US
Practice Address - Phone:509-488-2651
Practice Address - Fax:509-488-3243
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251030050291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice