Provider Demographics
NPI:1982751251
Name:GOLDEN, RICHARD KELLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KELLY
Last Name:GOLDEN
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 1:692 DILLARD RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-5384
Mailing Address - Country:US
Mailing Address - Phone:434-846-1981
Mailing Address - Fax:434-847-6383
Practice Address - Street 1:692 DILLARD RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-5384
Practice Address - Country:US
Practice Address - Phone:434-846-1981
Practice Address - Fax:434-847-6383
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice