Provider Demographics
NPI:1598808883
Name:RICHARDS, CARTER L (DDS, PC)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 HERON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7229
Mailing Address - Country:US
Mailing Address - Phone:757-721-0368
Mailing Address - Fax:
Practice Address - Street 1:940 GENERAL BOOTH BLVD
Practice Address - Street 2:SUITE #C
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4857
Practice Address - Country:US
Practice Address - Phone:757-425-1125
Practice Address - Fax:757-428-1188
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA88391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice