Provider Demographics
NPI:1912249798
Name:FENTERS, RICHARD A JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:FENTERS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3204
Mailing Address - Country:US
Mailing Address - Phone:407-679-5151
Mailing Address - Fax:407-679-2465
Practice Address - Street 1:4051 N DEAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3204
Practice Address - Country:US
Practice Address - Phone:407-679-5151
Practice Address - Fax:407-679-2465
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist