Provider Demographics
NPI:1598373839
Name:RICHARDS, NICOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
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 1:11327 EXPO BLVD APT 512
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1741
Mailing Address - Country:US
Mailing Address - Phone:210-454-1997
Mailing Address - Fax:
Practice Address - Street 1:20122 STONE OAK PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7041
Practice Address - Country:US
Practice Address - Phone:210-495-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice