Provider Demographics
NPI:1083911341
Name:LEWIS H. RICHARDSON DDS, INC.
Entity Type:Organization
Organization Name:LEWIS H. RICHARDSON DDS, INC.
Other - Org Name:ROMIE LANE DENTAL GROUP, LEWIS H. RICHARDSON, DDS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-424-3035
Mailing Address - Street 1:770 E. ROMIE LANE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901
Mailing Address - Country:US
Mailing Address - Phone:831-424-3035
Mailing Address - Fax:831-424-0590
Practice Address - Street 1:770 E. ROMIE LANE
Practice Address - Street 2:SUITE A-1
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-424-3035
Practice Address - Fax:831-424-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA218271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty