Provider Demographics
NPI:1801950902
Name:RICHMAN, PAUL THEODORE (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:THEODORE
Last Name:RICHMAN
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 1:1045 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:N MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161
Mailing Address - Country:US
Mailing Address - Phone:305-891-3306
Mailing Address - Fax:305-891-4476
Practice Address - Street 1:1045 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:N MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161
Practice Address - Country:US
Practice Address - Phone:305-891-3306
Practice Address - Fax:305-891-4476
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN32031223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
T85569Medicare UPIN
83236Medicare ID - Type Unspecified