Provider Demographics
NPI:1902841364
Name:RICHARDSON & MONROE, DDS, PA
Entity Type:Organization
Organization Name:RICHARDSON & MONROE, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-224-0144
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-224-0144
Mailing Address - Fax:501-224-0355
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-224-0144
Practice Address - Fax:501-224-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty