Provider Demographics
NPI:1316043995
Name:RICHARDS, MELZAR THAYER (DDS)
Entity type:Individual
Prefix:DR
First Name:MELZAR
Middle Name:THAYER
Last Name:RICHARDS
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 1:22 ARROWWOOD DR
Mailing Address - Street 2:STE C
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1857
Mailing Address - Country:US
Mailing Address - Phone:607-257-1010
Mailing Address - Fax:607-257-1982
Practice Address - Street 1:22 ARROWWOOD DR
Practice Address - Street 2:STE C
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-257-1010
Practice Address - Fax:607-257-1982
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0312601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00420902Medicaid