Provider Demographics
NPI:1144207903
Name:RICHARDS, JASON L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 S VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3450
Mailing Address - Country:US
Mailing Address - Phone:419-882-7187
Mailing Address - Fax:419-882-3165
Practice Address - Street 1:5860 ALEXIS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2347
Practice Address - Country:US
Practice Address - Phone:419-882-7187
Practice Address - Fax:419-882-3165
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH217211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry