Provider Demographics
NPI:1861514572
Name:HINES, RICHARD A (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:HINES
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 1:11237 NALL AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1639
Mailing Address - Country:US
Mailing Address - Phone:913-491-5548
Mailing Address - Fax:913-491-0793
Practice Address - Street 1:11237 NALL AVE STE 140
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1639
Practice Address - Country:US
Practice Address - Phone:913-491-5548
Practice Address - Fax:913-491-0793
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics