Provider Demographics
NPI:1255349254
Name:RICHARDSON, WILLIAM CURTIS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CURTIS
Last Name:RICHARDSON
Suffix:JR
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 1:101 CANDLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2654
Mailing Address - Country:US
Mailing Address - Phone:434-239-9289
Mailing Address - Fax:434-237-6453
Practice Address - Street 1:101 CANDLEWOOD CT
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2654
Practice Address - Country:US
Practice Address - Phone:434-239-9289
Practice Address - Fax:434-237-6453
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010051941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
006127OtherBLUE CROSS BLUE SHIELD
9178500OtherDORAL
VA007920971Medicaid