Provider Demographics
NPI:1396842282
Name:RICHARDSON, EUGENE ARTHUR III (DDS)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:ARTHUR
Last Name:RICHARDSON
Suffix:III
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 1:23 SHORE STREET
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803
Mailing Address - Country:US
Mailing Address - Phone:804-861-5331
Mailing Address - Fax:804-861-5351
Practice Address - Street 1:23 SHORE STREET
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803
Practice Address - Country:US
Practice Address - Phone:804-861-5331
Practice Address - Fax:804-861-5351
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178831Medicaid
VA003363OtherBCBS ANTHEM DENTAL
VA4066921OtherBCBS TENNESSEE