Provider Demographics
NPI:1912771502
Name:ANTHONY, RICHARD JEROME (DDS MS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JEROME
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 CHESHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-6238
Mailing Address - Country:US
Mailing Address - Phone:925-487-4270
Mailing Address - Fax:
Practice Address - Street 1:4165 BLACKHAWK PLAZA CIR STE 260
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4691
Practice Address - Country:US
Practice Address - Phone:925-736-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS340251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics