Provider Demographics
NPI:1629163555
Name:RICHARDS, DREW D (DDS)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:D
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 1:272 E CENTER ST
Mailing Address - Street 2:STE 205
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6456
Mailing Address - Country:US
Mailing Address - Phone:435-652-8111
Mailing Address - Fax:
Practice Address - Street 1:272 E CENTER ST
Practice Address - Street 2:STE 205
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6456
Practice Address - Country:US
Practice Address - Phone:435-652-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6860122300000X
UT8767233-8906122300000X
NV3477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist