Provider Demographics
NPI:1457333270
Name:RICHARDSON, GREGORY P (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:RICHARDSON
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Gender:M
Credentials:DMD
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Mailing Address - Street 1:131 INDIAN LAKE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6210
Mailing Address - Country:US
Mailing Address - Phone:615-822-8403
Mailing Address - Fax:615-822-0542
Practice Address - Street 1:131 INDIAN LAKE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6210
Practice Address - Country:US
Practice Address - Phone:615-822-8403
Practice Address - Fax:615-822-0542
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN70031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU53196Medicare UPIN