Provider Demographics
NPI:1841428372
Name:RICHARDS, JAKE RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:RUSSELL
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 1:105 W 13TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 W 13TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3082
Practice Address - Country:US
Practice Address - Phone:785-623-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSPENDING122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist