MEDICARE: DR. RICHARD WILLIAM STANDAGE DMD

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	122300000X	Dentist	7295	AZ
2	1223G0001X	General Practice Dentistry	7295	AZ

General Provider Information

NPI Number	:	1790984896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WILLIAM STANDAGE DMD

Provider Business Mailing Address
First Line	:	1255 FRANKLIN BLUFF DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7708
Country	:	US
Telephone Number	:	480-828-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 128 CHAFFEE RD.
Second Line	:	FORT BLISS DENTAC
City	:	FT BLISS
State	:	TX
Zip	:	79916
Country	:	US
Telephone Number	:	915-742-6001
Fax Number	:

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	06/16/2016

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