Healthcare Provider Details

I. General information

NPI: 1174646731
Provider Name (Legal Business Name): RICHARD LOUIS RYCHETSKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 LONGMIRE DR
COLLEGE STATION TX
77845-5812
US

IV. Provider business mailing address

3334 LONGMIRE DR
COLLEGE STATION TX
77845-5812
US

V. Phone/Fax

Practice location:
  • Phone: 979-693-1511
  • Fax: 979-695-1403
Mailing address:
  • Phone: 979-693-1511
  • Fax: 979-695-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: