Provider Demographics
NPI:1285719757
Name:COURSON, RICHARD C (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:COURSON
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 1:1100 WARD AVE STE 820
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1617
Mailing Address - Country:US
Mailing Address - Phone:808-528-2444
Mailing Address - Fax:808-524-6866
Practice Address - Street 1:1100 WARD AVE STE 820
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1617
Practice Address - Country:US
Practice Address - Phone:808-528-2444
Practice Address - Fax:808-524-6866
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11121223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics