Provider Demographics
NPI:1770682502
Name:RICHARDS, PETER NEAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NEAL
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 1:4324 COVINGTON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035
Mailing Address - Country:US
Mailing Address - Phone:404-289-6454
Mailing Address - Fax:404-289-2570
Practice Address - Street 1:4324 COVINGTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035
Practice Address - Country:US
Practice Address - Phone:404-289-6454
Practice Address - Fax:404-289-2570
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist