Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 18970 | MA |
NPI | 1063573988 |
---|---|
Provider Name | Dr. Donald C Richard JR. |
First Address | Wakefield, MA 01880-3178 |
Second Address | Waltham, MA 02451-7414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |