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General NPI Number Information
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NPI Number | 1922325943
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Entity Type | Individual
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Provider Name | RICHARD WILLIAM HOMPESCH III D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 2009 COWLES ST
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City | FAIRBANKS
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State | AK
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Zip | 99701-5916
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Country | US
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Telephone | 907-374-8111
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Fax | 907-374-8119
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Provider Business Mailing Address
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Address Line | 119 N CUSHMAN ST STE 400
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City | FAIRBANKS
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State | AK
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Zip | 99701-2879
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Country | US
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Telephone | 907-978-1535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 105542
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License Number State | AK
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