MEDICARE: DR. RICHARD WALTER PORTUNE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	OH 13975	OH

General Provider Information

NPI Number	:	1154324143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WALTER PORTUNE D.D.S.

Provider Business Mailing Address
First Line	:	3882 FEEDWIRE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3913
Country	:	US
Telephone Number	:	937-848-8771
Fax Number	:

Provider Business Practice Location Address
First Line	:	2591 MIAMISBURG CENTERVILLE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-3711
Country	:	US
Telephone Number	:	937-434-3757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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