Provider Demographics
NPI:1003606328
Name:RICHARDSON, TASHIKIA (RDH)
Entity type:Individual
Prefix:
First Name:TASHIKIA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 HOLLY OAK WAY
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75087-1229
Mailing Address - Country:US
Mailing Address - Phone:407-693-3218
Mailing Address - Fax:
Practice Address - Street 1:1500 N GRANT ST STE N
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1859
Practice Address - Country:US
Practice Address - Phone:407-693-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002027285124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist