Healthcare Provider Details

I. General information

NPI: 1427217686
Provider Name (Legal Business Name): DR. RICHARD C. APODACA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S. CHESTNUT AVE
EARLHAM IA
50072-0190
US

IV. Provider business mailing address

110 S. CHESTNUT AVE PO BOX 190
EARLHAM IA
50072-0190
US

V. Phone/Fax

Practice location:
  • Phone: 515-758-2323
  • Fax: 515-758-3031
Mailing address:
  • Phone: 515-758-2323
  • Fax: 515-758-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD C. APODACA
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 515-758-2323