Provider Demographics
NPI:1972552057
Name:SIXKILLER, RICHARD VINCE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VINCE
Last Name:SIXKILLER
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 1:1211 N EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1306
Mailing Address - Country:US
Mailing Address - Phone:209-462-2049
Mailing Address - Fax:
Practice Address - Street 1:1211 N EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1306
Practice Address - Country:US
Practice Address - Phone:209-462-2049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD291901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice