Provider Demographics
NPI:1295145274
Name:RICHART, CALEY (RDH)
Entity type:Individual
Prefix:
First Name:CALEY
Middle Name:
Last Name:RICHART
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CALEY
Other - Middle Name:LEIGH
Other - Last Name:PEDIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1631 WETZEL AVE
Mailing Address - Street 2:BLDG 815
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4095
Mailing Address - Country:US
Mailing Address - Phone:719-526-5537
Mailing Address - Fax:719-524-2843
Practice Address - Street 1:1631 WETZEL AVE
Practice Address - Street 2:BLDG 815
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4095
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:719-524-2843
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH002023721124Q00000X
TNDH0000006687124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist