Provider Demographics
NPI:1124048962
Name:LUSBY, RICHARD ELDRED (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ELDRED
Last Name:LUSBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10230
Mailing Address - Street 2:308 DORLA COURT SUITE 202
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-2230
Mailing Address - Country:US
Mailing Address - Phone:775-588-8484
Mailing Address - Fax:775-588-6143
Practice Address - Street 1:308 DORLA COURT
Practice Address - Street 2:SUITE 202
Practice Address - City:ZEPHYR COVE
Practice Address - State:NV
Practice Address - Zip Code:89449
Practice Address - Country:US
Practice Address - Phone:775-588-8484
Practice Address - Fax:775-588-6143
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist