Provider Demographics
NPI:1548343858
Name:RICHARDSON, DAVID S (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:RICHARDSON
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 1:67 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-3407
Mailing Address - Country:US
Mailing Address - Phone:860-889-5213
Mailing Address - Fax:860-886-0100
Practice Address - Street 1:67 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-3407
Practice Address - Country:US
Practice Address - Phone:860-889-5213
Practice Address - Fax:860-886-0100
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75681223G0001X
CT93451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice