Provider Demographics
NPI:1386640167
Name:RICHMAN, COLIN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:S
Last Name:RICHMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 HEMBREE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3810
Mailing Address - Country:US
Mailing Address - Phone:770-442-1010
Mailing Address - Fax:404-252-4464
Practice Address - Street 1:1305 HEMBREE RD
Practice Address - Street 2:STE 104
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3810
Practice Address - Country:US
Practice Address - Phone:770-442-1010
Practice Address - Fax:404-252-4464
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 92851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics