Provider Demographics
NPI:1982636791
Name:AULICINO, RICHARD R (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:AULICINO
Suffix:
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 1:1849 RT. 9
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845
Mailing Address - Country:US
Mailing Address - Phone:518-668-9888
Mailing Address - Fax:
Practice Address - Street 1:1849 RT. 9
Practice Address - Street 2:
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845
Practice Address - Country:US
Practice Address - Phone:518-668-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY0299871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice