Provider Demographics
NPI:1245476050
Name:RICHARDSON, MARLENE K (DMD)
Entity type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:K
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-3356
Mailing Address - Country:US
Mailing Address - Phone:270-789-2155
Mailing Address - Fax:270-789-0693
Practice Address - Street 1:1485 OLD LEBANON RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-3356
Practice Address - Country:US
Practice Address - Phone:270-789-2155
Practice Address - Fax:270-789-0693
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY395470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist