Provider Demographics
NPI:1932671310
Name:RICHARDSON, DEXTER M
Entity Type:Individual
Prefix:
First Name:DEXTER
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 CLEAR SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5890
Mailing Address - Country:US
Mailing Address - Phone:804-681-0346
Mailing Address - Fax:
Practice Address - Street 1:1617 CLEAR SPRINGS CT
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23834-5890
Practice Address - Country:US
Practice Address - Phone:804-681-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)