Provider Demographics
NPI:1164573432
Name:RICHARDS, ANTHONY IRVING (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:IRVING
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 STOCKHOLM ST
Mailing Address - Street 2:DEPARTMENT OF DENTAL MEDICINE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4006
Mailing Address - Country:US
Mailing Address - Phone:718-963-7174
Mailing Address - Fax:718-963-6744
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:DEPARTMENT OF DENTAL MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-963-7174
Practice Address - Fax:718-963-6744
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU94280Medicare UPIN