Provider Demographics
NPI:1215929617
Name:DIAL, RICHARD D (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:DIAL
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 1:363 S HARLAN ST
Mailing Address - Street 2:STE 110
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3571
Mailing Address - Country:US
Mailing Address - Phone:303-935-6559
Mailing Address - Fax:303-935-5408
Practice Address - Street 1:363 S HARLAN ST
Practice Address - Street 2:STE 110
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3571
Practice Address - Country:US
Practice Address - Phone:303-935-6559
Practice Address - Fax:303-935-5408
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02064111Medicaid