Provider Demographics
NPI:1649588625
Name:RICHARDSON, DIONNE JOHNSON (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:DIONNE
Middle Name:JOHNSON
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10526 N OAK HILLS PKWY
Mailing Address - Street 2:UNIT C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7813
Mailing Address - Country:US
Mailing Address - Phone:504-377-6342
Mailing Address - Fax:225-775-3569
Practice Address - Street 1:12841 PLANK RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4908
Practice Address - Country:US
Practice Address - Phone:225-775-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist