1457550006 NPI number — RICHARD C. RIBEIRO

Table of content: (NPI 1457550006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457550006 NPI number — RICHARD C. RIBEIRO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD C. RIBEIRO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457550006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2305 RUDOLPHTOWN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-645-6362
Provider Business Mailing Address Fax Number:
931-645-6369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 RUDOLPHTOWN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-645-6362
Provider Business Practice Location Address Fax Number:
931-645-6369
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIBEIRO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
931-645-6362

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  7505 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7505 . This is a "DENTAL LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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