Provider Demographics
NPI:1528104593
Name:PIPER, RICHARD A (DDS)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:PIPER
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 1:4460 ROSALIE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-2508
Mailing Address - Country:US
Mailing Address - Phone:314-814-8587
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:6121 N HANLEY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-2003
Practice Address - Country:US
Practice Address - Phone:314-615-0500
Practice Address - Fax:314-615-8303
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01406991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2958OtherDODS
MO402771752Medicaid