Provider Demographics
NPI:1730250903
Name:DECKER, RICHARD MYRON (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MYRON
Last Name:DECKER
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 1:7402 CUSTER RD W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-7944
Mailing Address - Country:US
Mailing Address - Phone:253-471-2222
Mailing Address - Fax:253-476-2647
Practice Address - Street 1:7402 CUSTER RD W
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-7944
Practice Address - Country:US
Practice Address - Phone:253-471-2222
Practice Address - Fax:253-476-2647
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA059911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA05991OtherDETAL LICENSE