Provider Demographics
NPI:1982922506
Name:SCHALK, RICHARD S JR (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:SCHALK
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 1:647 HOLCOMB BRIDGE RD
Mailing Address - Street 2:COAST DENTAL
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1511
Mailing Address - Country:US
Mailing Address - Phone:770-641-1595
Mailing Address - Fax:
Practice Address - Street 1:647 HOLCOMB BRIDGE RD
Practice Address - Street 2:COAST DENTAL
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1511
Practice Address - Country:US
Practice Address - Phone:770-641-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46791223G0001X
GADN013955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice