Provider Demographics
NPI:1386974954
Name:TEST, RICHARD KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENNETH
Last Name:TEST
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 1:2929 MOSSROCK
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5110
Mailing Address - Country:US
Mailing Address - Phone:210-340-3511
Mailing Address - Fax:210-340-3551
Practice Address - Street 1:2929 MOSSROCK
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5110
Practice Address - Country:US
Practice Address - Phone:210-340-3511
Practice Address - Fax:210-340-3551
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice