Provider Demographics
NPI:1265845820
Name:RICHARDSON, ZACHARY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:MICHAEL
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 1:6144 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-4148
Mailing Address - Country:US
Mailing Address - Phone:208-936-7111
Mailing Address - Fax:
Practice Address - Street 1:782 S AMERICANA BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6733
Practice Address - Country:US
Practice Address - Phone:208-345-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist