Provider Demographics
NPI:1487750832
Name:AKIN, RICHARD B (DMD,PA)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:AKIN
Suffix:
Gender:M
Credentials:DMD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W GALLATIN ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-3027
Mailing Address - Country:US
Mailing Address - Phone:601-894-1634
Mailing Address - Fax:
Practice Address - Street 1:331 W GALLATIN ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-3027
Practice Address - Country:US
Practice Address - Phone:601-894-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1822-791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660340Medicaid
MS00660340OtherBLUE CROSS BLUE SHIELD
MS704981OtherUNITED CONCORDIA