Provider Demographics
NPI:1225164734
Name:RICHMOND, PAUL STEPHEN (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:STEPHEN
Last Name:RICHMOND
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 1:410 N BROAD STREET
Mailing Address - Street 2:PO BOX 806
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932
Mailing Address - Country:US
Mailing Address - Phone:252-482-2181
Mailing Address - Fax:252-482-4468
Practice Address - Street 1:410 N BROAD STREET
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932
Practice Address - Country:US
Practice Address - Phone:252-482-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice