Provider Demographics
NPI:1538282074
Name:K.A. RICHARDT DDS A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:K.A. RICHARDT DDS A PROFESSIONAL CORP
Other - Org Name:BARSTOW DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RICHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-256-7777
Mailing Address - Street 1:P.O. BOX 10
Mailing Address - Street 2:307 EAST BUENA VISTA STREET
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-1052
Mailing Address - Country:US
Mailing Address - Phone:760-256-7777
Mailing Address - Fax:760-256-1899
Practice Address - Street 1:307 EAST BUENA VISTA STREET
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-1052
Practice Address - Country:US
Practice Address - Phone:760-256-7777
Practice Address - Fax:760-256-1899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K.A. RICHARDT DDS A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB344101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty