Healthcare Provider Details

I. General information

NPI: 1952894909
Provider Name (Legal Business Name): RICHARD ANTHONY LAW DDS, MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 OCOEE ST N STE 2
CLEVELAND TN
37312-4886
US

IV. Provider business mailing address

4160 OCOEE ST N STE 2
CLEVELAND TN
37312-4886
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-9930
  • Fax:
Mailing address:
  • Phone: 423-541-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10765
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0000010765
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: