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NPI Code Detail

MEDICARE: DR. RICHARD BARRY WAGHALTER DDS

MEDICARE: DR. RICHARD BARRY WAGHALTER DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0300XPeriodontics9404TX

General Provider Information

NPI Number : 1437160892
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD BARRY WAGHALTER DDS
Provider Business Mailing Address
First Line : 6065 HILLCROFT ST STE 207
Second Line :
City : HOUSTON
State : TX
Zip : 77081-1005
Country : US
Telephone Number : 713-771-7101
Fax Number : 713-771-7102
Provider Business Practice Location Address
First Line : 6065 HILLCROFT ST STE 207
Second Line :
City : HOUSTON
State : TX
Zip : 77081-1005
Country : US
Telephone Number : 713-771-7101
Fax Number : 713-771-7102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 07/08/2007

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