Provider Demographics
NPI:1891862546
Name:RICHARDS, TOBY G (DDS)
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:G
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 1:1240 DEWEY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3411
Mailing Address - Country:US
Mailing Address - Phone:406-494-2525
Mailing Address - Fax:406-494-2508
Practice Address - Street 1:1240 DEWEY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3411
Practice Address - Country:US
Practice Address - Phone:406-494-2525
Practice Address - Fax:406-494-2508
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0130793Medicaid