Provider Demographics
NPI:1144435421
Name:RICHARDS, ROBERT DONOLD (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DONOLD
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 1:1524 BROOKSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2713
Mailing Address - Country:US
Mailing Address - Phone:906-482-1365
Mailing Address - Fax:906-482-7334
Practice Address - Street 1:896 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49931-1571
Practice Address - Country:US
Practice Address - Phone:906-482-8527
Practice Address - Fax:906-482-7334
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010131951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice