Provider Demographics
NPI:1558434704
Name:RICHARDSON-FOOTE, NORA SHIPP (DDS)
Entity Type:Individual
Prefix:MRS
First Name:NORA
Middle Name:SHIPP
Last Name:RICHARDSON-FOOTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:NORA
Other - Middle Name:SHIPP
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:328 S. BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3440
Mailing Address - Country:US
Mailing Address - Phone:225-647-1900
Mailing Address - Fax:225-647-1905
Practice Address - Street 1:328 S. BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3440
Practice Address - Country:US
Practice Address - Phone:225-647-1900
Practice Address - Fax:225-647-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1852741Medicaid