Provider Demographics
NPI:1174656094
Name:RICHARDSON, JOSEPH ELMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ELMER
Last Name:RICHARDSON
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 1:321 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-1424
Mailing Address - Country:US
Mailing Address - Phone:417-967-4528
Mailing Address - Fax:417-967-0068
Practice Address - Street 1:321 S 2ND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-1424
Practice Address - Country:US
Practice Address - Phone:417-967-4528
Practice Address - Fax:417-967-0068
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0135891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice