Provider Demographics
NPI:1992863336
Name:RICHARDSON, JAMES EDGAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDGAR
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 1:2563 ROLLING HILLS RD
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-9614
Mailing Address - Country:US
Mailing Address - Phone:315-672-3672
Mailing Address - Fax:
Practice Address - Street 1:314 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2351
Practice Address - Country:US
Practice Address - Phone:315-592-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist