Provider Demographics
NPI:1760814735
Name:RICHARDS, SPENCER RAYMOND (DDS)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:RAYMOND
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 1:2002 VINTON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1921
Mailing Address - Country:US
Mailing Address - Phone:402-341-5306
Mailing Address - Fax:402-346-1905
Practice Address - Street 1:2002 VINTON ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1921
Practice Address - Country:US
Practice Address - Phone:402-341-5306
Practice Address - Fax:402-346-1905
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7113122300000X
IA09333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist