Provider Demographics
NPI:1407161466
Name:RICHMOND, WHITNEY M (DDS)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:M
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1618
Mailing Address - Country:US
Mailing Address - Phone:574-533-9621
Mailing Address - Fax:
Practice Address - Street 1:1908 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1618
Practice Address - Country:US
Practice Address - Phone:574-533-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011458A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice