Provider Demographics
NPI:1902160492
Name:RATHKE, RICHARD MARTIN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARTIN
Last Name:RATHKE
Suffix:JR
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 1:1018 WASHINGTON AVE APT C
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-5540
Mailing Address - Country:US
Mailing Address - Phone:985-774-6193
Mailing Address - Fax:
Practice Address - Street 1:8229 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-4617
Practice Address - Country:US
Practice Address - Phone:504-739-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice