Provider Demographics
NPI:1417393844
Name:STEIN, RICHARD J (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:STEIN
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 1:208 W ROSS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2103
Mailing Address - Country:US
Mailing Address - Phone:620-225-5682
Mailing Address - Fax:620-225-5383
Practice Address - Street 1:208 W ROSS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2103
Practice Address - Country:US
Practice Address - Phone:620-225-5682
Practice Address - Fax:620-225-5383
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice