Provider Demographics
NPI:1770653719
Name:RICHARDSON, BRENDA KATHERINE (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KATHERINE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CHESTNUT WOODS CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5523
Mailing Address - Country:US
Mailing Address - Phone:410-628-0970
Mailing Address - Fax:
Practice Address - Street 1:515 E JOPPA RD
Practice Address - Street 2:STU. 106
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5418
Practice Address - Country:US
Practice Address - Phone:410-321-5700
Practice Address - Fax:410-321-9573
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD99381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics