Provider Demographics
NPI:1033509435
Name:JOHN V.D. RICHARDSON, DDS., INC
Entity Type:Organization
Organization Name:JOHN V.D. RICHARDSON, DDS., INC
Other - Org Name:JOHN D RICHARDSON DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VERNON DALE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-992-4138
Mailing Address - Street 1:1409 WHITLEY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-2223
Mailing Address - Country:US
Mailing Address - Phone:559-992-4138
Mailing Address - Fax:559-992-4079
Practice Address - Street 1:1409 WHITLEY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2223
Practice Address - Country:US
Practice Address - Phone:559-992-4138
Practice Address - Fax:559-992-4079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN V.D. RICHARDSON DDS., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39700261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255480406OtherINDIVIDUAL NPI
1223000000XOtherTAXONOMY CODE