Provider Demographics
NPI:1194781419
Name:FIXOTT, RICHARD H (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:FIXOTT
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 1:3818 SW 21ST PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7771
Mailing Address - Country:US
Mailing Address - Phone:541-923-5927
Mailing Address - Fax:541-923-5962
Practice Address - Street 1:3818 SW 21ST PL
Practice Address - Street 2:SUITE 202
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-7771
Practice Address - Country:US
Practice Address - Phone:541-923-5927
Practice Address - Fax:541-923-5962
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR58121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice