Provider Demographics
NPI:1922196245
Name:RICHARD W. MAINS,JR.,D.M.D., PC
Entity type:Organization
Organization Name:RICHARD W. MAINS,JR.,D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MAINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:585-586-6670
Mailing Address - Street 1:625 PANORAMA TRL
Mailing Address - Street 2:BLDG 2, SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2404
Mailing Address - Country:US
Mailing Address - Phone:585-586-6670
Mailing Address - Fax:585-586-6701
Practice Address - Street 1:625 PANORAMA TRL
Practice Address - Street 2:BLDG 2, SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2404
Practice Address - Country:US
Practice Address - Phone:585-586-6670
Practice Address - Fax:585-586-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty