Provider Demographics
NPI:1275686446
Name:RICHARDS, BRIAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1872 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4878
Mailing Address - Country:US
Mailing Address - Phone:309-797-3020
Mailing Address - Fax:309-797-3212
Practice Address - Street 1:1872 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4878
Practice Address - Country:US
Practice Address - Phone:309-797-3020
Practice Address - Fax:309-797-3212
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190252641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry