Provider Demographics
NPI:1023499597
Name:RICHMOND, JACQUELINE NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:NICOLE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:NICOLE
Other - Last Name:DUBINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1560 MARKET ST APT 706
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-2466
Mailing Address - Country:US
Mailing Address - Phone:301-268-2605
Mailing Address - Fax:
Practice Address - Street 1:3705 E COLFAX AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1810
Practice Address - Country:US
Practice Address - Phone:303-399-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist