Provider Demographics
NPI:1508098849
Name:RICHARDS, DENNIS J (CO)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:J
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 JASON CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-1233
Mailing Address - Country:US
Mailing Address - Phone:314-256-9953
Mailing Address - Fax:314-584-2285
Practice Address - Street 1:25 JASON CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-1233
Practice Address - Country:US
Practice Address - Phone:314-256-9953
Practice Address - Fax:314-584-2285
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213000241222Z00000X
222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6630100001Medicare NSC