Provider Demographics
NPI:1184855967
Name:RICHARDSON, TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
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 1:4122 QUEST DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-8768
Mailing Address - Country:US
Mailing Address - Phone:541-844-1667
Mailing Address - Fax:541-505-8463
Practice Address - Street 1:4122 QUEST DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-8768
Practice Address - Country:US
Practice Address - Phone:541-844-1667
Practice Address - Fax:541-505-8463
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR95771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry