Provider Demographics
NPI:1518957885
Name:RICHARDSON, ELISHA R (DDS,MS,PHD)
Entity Type:Individual
Prefix:DR
First Name:ELISHA
Middle Name:R
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DDS,MS,PHD
Other - Prefix:DR
Other - First Name:ELISHA
Other - Middle Name:R
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,MS,PHD,
Mailing Address - Street 1:P.O. BOX 331248
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1248
Mailing Address - Country:US
Mailing Address - Phone:615-832-8989
Mailing Address - Fax:615-832-1101
Practice Address - Street 1:390 HARDING PL
Practice Address - Street 2:SUITE 106
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3998
Practice Address - Country:US
Practice Address - Phone:615-832-8989
Practice Address - Fax:615-832-1101
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000014561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3210222Medicaid