Provider Demographics
NPI:1679275739
Name:NI, RICHARD (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:NI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:OMFS DEPT, 4TH FLOOR SOUTH
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:156-623-5802
Mailing Address - Fax:215-662-7445
Practice Address - Street 1:3400 CIVIC CENTER BLVD FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-3580
Practice Address - Fax:215-662-7445
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program