Provider Demographics
NPI:1013330026
Name:DR MATT D RICHARDS DDS PS
Entity Type:Organization
Organization Name:DR MATT D RICHARDS DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-296-2728
Mailing Address - Street 1:17331 135TH AVE NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8596
Mailing Address - Country:US
Mailing Address - Phone:425-296-2728
Mailing Address - Fax:
Practice Address - Street 1:17331 135TH AVE NE
Practice Address - Street 2:SUITE D
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8596
Practice Address - Country:US
Practice Address - Phone:425-296-2728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60284255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty