Provider Demographics
NPI:1942290291
Name:RICHARDSON, PAUL EDWARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDWARD
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:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-2526
Mailing Address - Country:US
Mailing Address - Phone:828-322-1667
Mailing Address - Fax:828-485-3208
Practice Address - Street 1:3452 GRAYSTONE PLACE SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:828-322-1667
Practice Address - Fax:828-485-3208
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90167OtherBLUE CROSS BLUE SHIELD
NC1309318OtherTRICARE
NC8990167Medicaid
NC8990167Medicaid
NC2428854CMedicare ID - Type Unspecified