Provider Demographics
NPI:1073630620
Name:DEVITA, RICHARD NEIL (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:NEIL
Last Name:DEVITA
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 1:3000 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5107
Mailing Address - Country:US
Mailing Address - Phone:941-957-3636
Mailing Address - Fax:941-366-1299
Practice Address - Street 1:3000 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5107
Practice Address - Country:US
Practice Address - Phone:941-957-3636
Practice Address - Fax:941-366-1299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00095901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60050Medicare ID - Type Unspecified