Provider Demographics
NPI:1639542632
Name:RICHMOND, H JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:JOHN
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:JOHN
Other - Last Name:RICHMOND
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1906 59TH ST W
Mailing Address - Street 2:SUITE H
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4639
Mailing Address - Country:US
Mailing Address - Phone:941-761-9603
Mailing Address - Fax:941-794-8380
Practice Address - Street 1:1906 59TH ST W
Practice Address - Street 2:SUITE H
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4639
Practice Address - Country:US
Practice Address - Phone:941-761-9603
Practice Address - Fax:941-794-8380
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist