Provider Demographics
NPI:1760509020
Name:RICHERZHAGEN, BRIAN MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:RICHERZHAGEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 GRANTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210-1204
Mailing Address - Country:US
Mailing Address - Phone:205-956-8977
Mailing Address - Fax:205-956-8340
Practice Address - Street 1:3920 GRANTS MILL RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-1204
Practice Address - Country:US
Practice Address - Phone:205-956-8977
Practice Address - Fax:205-956-8340
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL50581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice