Provider Demographics
NPI:1174748610
Name:WAMPOLD, RICHARD L (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:WAMPOLD
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 1:7179 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8114
Mailing Address - Country:US
Mailing Address - Phone:225-927-5445
Mailing Address - Fax:225-927-4871
Practice Address - Street 1:7179 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8114
Practice Address - Country:US
Practice Address - Phone:225-927-5445
Practice Address - Fax:225-927-4871
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice