Provider Demographics
NPI:1821050527
Name:RICHARDS, HARRY ED (DMD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:ED
Last Name:RICHARDS
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 1:121 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1212
Mailing Address - Country:US
Mailing Address - Phone:814-849-3400
Mailing Address - Fax:814-849-5522
Practice Address - Street 1:121 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1212
Practice Address - Country:US
Practice Address - Phone:814-849-3400
Practice Address - Fax:814-849-5522
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022430L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA135702OtherUNITED CONCORDIA
PA0010846310001Medicaid
PA71016OtherGEISINGER
PA0010846310001Medicaid