Provider Demographics
NPI:1043305709
Name:PRINE, RICHARD G (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:PRINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5955
Mailing Address - Country:US
Mailing Address - Phone:816-478-4204
Mailing Address - Fax:816-478-8920
Practice Address - Street 1:12600 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5955
Practice Address - Country:US
Practice Address - Phone:816-478-4204
Practice Address - Fax:816-478-8920
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO011990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist