Provider Demographics
NPI:1548371768
Name:PYUN, RICHARD W (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:PYUN
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 1:2503 LAKE DWELLER LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3153
Mailing Address - Country:US
Mailing Address - Phone:201-819-8974
Mailing Address - Fax:
Practice Address - Street 1:5513 TN-153, SUITE 125
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:201-819-8974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1225641223G0001X
NY047009122300000X
TN117401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist