Provider Demographics
NPI:1902184476
Name:RICHARDSON, CHRISTOPHER BLAKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BLAKE
Last Name:RICHARDSON
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 1:1661 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4107
Mailing Address - Country:US
Mailing Address - Phone:903-872-1661
Mailing Address - Fax:903-872-5961
Practice Address - Street 1:1661 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110
Practice Address - Country:US
Practice Address - Phone:903-872-1661
Practice Address - Fax:903-872-5961
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX272741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice