Provider Demographics
NPI:1659584670
Name:DAVID W RICHARDS, DDS, PHD
Entity Type:Organization
Organization Name:DAVID W RICHARDS, DDS, PHD
Other - Org Name:SAN DIEGO PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-543-0905
Mailing Address - Street 1:4060 4TH AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2116
Mailing Address - Country:US
Mailing Address - Phone:619-543-0905
Mailing Address - Fax:619-543-0422
Practice Address - Street 1:4060 4TH AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-543-0905
Practice Address - Fax:619-543-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty