Provider Demographics
NPI:1083755748
Name:RICHARDSON, PATRICIA J (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:RICHARDSON
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 1:2945 TRIVERTON PIKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7509
Mailing Address - Country:US
Mailing Address - Phone:608-274-4701
Mailing Address - Fax:608-274-4191
Practice Address - Street 1:2945 TRIVERTON PIKE DR STE 100
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7509
Practice Address - Country:US
Practice Address - Phone:608-274-4701
Practice Address - Fax:608-274-4191
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice