Provider Demographics
NPI:1043427941
Name:MARGESON, RICHMAN M (DM D)
Entity Type:Individual
Prefix:
First Name:RICHMAN
Middle Name:M
Last Name:MARGESON
Suffix:
Gender:M
Credentials:DM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-0681
Mailing Address - Country:US
Mailing Address - Phone:229-888-3550
Mailing Address - Fax:229-888-0055
Practice Address - Street 1:919 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4880
Practice Address - Country:US
Practice Address - Phone:229-888-3550
Practice Address - Fax:229-888-0055
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist