Provider Demographics
NPI:1841475480
Name:BILLINGSLEY RICHARDSON, JENNIFER MORGAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MORGAN
Last Name:BILLINGSLEY RICHARDSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11123 CHANTILLY PKWY CT
Mailing Address - Street 2:SUITE I
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2880
Mailing Address - Country:US
Mailing Address - Phone:334-270-7751
Mailing Address - Fax:334-270-7741
Practice Address - Street 1:11123 CHANTILLY PKWY CT
Practice Address - Street 2:SUITE I
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064-2880
Practice Address - Country:US
Practice Address - Phone:334-270-7751
Practice Address - Fax:334-270-7741
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL55861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice