Healthcare Provider Details

I. General information

NPI: 1740258276
Provider Name (Legal Business Name): RICHARD THOMAS O'DAY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 CLUB CREST DR
ARVADA CO
80005-2269
US

IV. Provider business mailing address

8025 CLUB CREST DR
ARVADA CO
80005-2269
US

V. Phone/Fax

Practice location:
  • Phone: 303-431-0033
  • Fax: 303-431-0507
Mailing address:
  • Phone: 303-431-0033
  • Fax: 303-431-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0796
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: