Provider Demographics
NPI:1588295364
Name:RDEST, DDS,PLLC IV
Entity type:Organization
Organization Name:RDEST, DDS,PLLC IV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-737-3133
Mailing Address - Street 1:201 MCCULLOUGH DR STE 180
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1302
Mailing Address - Country:US
Mailing Address - Phone:704-790-4410
Mailing Address - Fax:
Practice Address - Street 1:201 MCCULLOUGH DR STE 180
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1302
Practice Address - Country:US
Practice Address - Phone:704-790-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty