Provider Demographics
NPI:1568493187
Name:RICHARDS, HARLEY MERCER (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARLEY
Middle Name:MERCER
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HARDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5917
Mailing Address - Country:US
Mailing Address - Phone:863-665-8878
Mailing Address - Fax:863-665-1096
Practice Address - Street 1:2150 HARDEN BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5917
Practice Address - Country:US
Practice Address - Phone:863-665-8878
Practice Address - Fax:863-665-1096
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 74011223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology