Provider Demographics
NPI:1831400910
Name:DERKSEN, RICHARD BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRIAN
Last Name:DERKSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 PRESTON RD
Mailing Address - Street 2:SUITE 750
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6203
Mailing Address - Country:US
Mailing Address - Phone:214-827-1150
Mailing Address - Fax:
Practice Address - Street 1:8201 PRESTON RD
Practice Address - Street 2:SUITE 750
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6203
Practice Address - Country:US
Practice Address - Phone:214-827-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice