Provider Demographics
NPI:1700910908
Name:RICHARDS, PHILIP S (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:RICHARDS
Suffix:
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 1:406 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3308
Mailing Address - Country:US
Mailing Address - Phone:734-998-9640
Mailing Address - Fax:734-998-9647
Practice Address - Street 1:406 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3308
Practice Address - Country:US
Practice Address - Phone:734-998-9640
Practice Address - Fax:734-998-9647
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013807122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID138070OtherBCBS OF MI DENTAL
MI1951360120OtherBCBS OF MI MED SURGICAL