Provider Demographics
NPI:1609145044
Name:RICHARDSON DENTISTRY, PLLC
Entity Type:Organization
Organization Name:RICHARDSON DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-690-8617
Mailing Address - Street 1:1231 E BELT LINE RD
Mailing Address - Street 2:SUITE103
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3748
Mailing Address - Country:US
Mailing Address - Phone:972-690-8617
Mailing Address - Fax:972-690-6423
Practice Address - Street 1:1231 E BELT LINE RD
Practice Address - Street 2:SUITE103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3748
Practice Address - Country:US
Practice Address - Phone:972-690-8617
Practice Address - Fax:972-690-6423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty