Provider Demographics
NPI:1467114660
Name:RICHMOND DENTAL CARE
Entity Type:Organization
Organization Name:RICHMOND DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:FOSSUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-595-2266
Mailing Address - Street 1:1840 FM 359 RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2049
Mailing Address - Country:US
Mailing Address - Phone:832-595-2266
Mailing Address - Fax:
Practice Address - Street 1:8019 W GRAND PKWY S STE 1055
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1603
Practice Address - Country:US
Practice Address - Phone:832-595-2285
Practice Address - Fax:832-595-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty