Provider Demographics
NPI:1720287998
Name:RICHARDSON, HEATHER R (DMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7384 S ALTON WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2369
Mailing Address - Country:US
Mailing Address - Phone:303-721-1173
Mailing Address - Fax:303-721-1179
Practice Address - Street 1:7384 S ALTON WAY
Practice Address - Street 2:STE 101
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2369
Practice Address - Country:US
Practice Address - Phone:303-721-1173
Practice Address - Fax:303-721-1179
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190264661223G0001X
CO94761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice