Provider Demographics
NPI:1134243462
Name:RICHARDS, PAUL M (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:RICHARDS
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 1:6700 NE 162ND AVE
Mailing Address - Street 2:SUITE 425
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3858
Mailing Address - Country:US
Mailing Address - Phone:360-882-1199
Mailing Address - Fax:360-882-1674
Practice Address - Street 1:6700 NE 162ND AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-3858
Practice Address - Country:US
Practice Address - Phone:360-882-1199
Practice Address - Fax:360-882-1674
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE8498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist