Provider Demographics
NPI:1306979018
Name:RICHARD, JOHN ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:RICHARD
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 1:5995 REEVES RD
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520
Mailing Address - Country:US
Mailing Address - Phone:717-569-0121
Mailing Address - Fax:717-569-4510
Practice Address - Street 1:5995 REEVES RD
Practice Address - Street 2:
Practice Address - City:EAST PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520
Practice Address - Country:US
Practice Address - Phone:717-569-0131
Practice Address - Fax:717-569-4510
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17668122300000X
PADS035292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist