Provider Demographics
NPI:1073604062
Name:RICHMAN, RACHELL DAWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHELL
Middle Name:DAWN
Last Name:RICHMAN
Suffix:
Gender:F
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:PO BOX 1439
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:CO
Mailing Address - Zip Code:81425-1439
Mailing Address - Country:US
Mailing Address - Phone:970-323-6828
Mailing Address - Fax:970-323-6186
Practice Address - Street 1:601 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:CO
Practice Address - Zip Code:81425
Practice Address - Country:US
Practice Address - Phone:970-323-6828
Practice Address - Fax:970-323-6186
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002030791223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1073604062Medicaid
CO1073604062Medicaid