Provider Demographics
NPI:1396296620
Name:RICHARDSON DMD, INC.
Entity type:Organization
Organization Name:RICHARDSON DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-229-5778
Mailing Address - Street 1:412 E PIONEER AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7621
Mailing Address - Country:US
Mailing Address - Phone:907-226-2218
Mailing Address - Fax:
Practice Address - Street 1:412 E PIONEER AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7621
Practice Address - Country:US
Practice Address - Phone:907-226-2218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1039387261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental