Provider Demographics
NPI:1316078447
Name:TIEGEN, RICHARD MILTON (AP, DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MILTON
Last Name:TIEGEN
Suffix:
Gender:M
Credentials:AP, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 MILITARY TRL STE 205
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4837
Mailing Address - Country:US
Mailing Address - Phone:561-624-9744
Mailing Address - Fax:561-623-0845
Practice Address - Street 1:4601 MILITARY TRL STE 205
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4837
Practice Address - Country:US
Practice Address - Phone:561-624-9744
Practice Address - Fax:561-623-0845
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP691171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist