Provider Demographics
NPI:1083890222
Name:RICHARDSON, AFUA A (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:AFUA
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:DR
Other - First Name:EFFIE
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MSD
Mailing Address - Street 1:5373 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3330 KINGMAN ST STE 1
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4235
Practice Address - Country:US
Practice Address - Phone:504-207-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0373981223G0001X, 1223P0221X
LA68331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice