Provider Demographics
NPI:1548347529
Name:TERRY R. RICHMOND, DDS, PA
Entity type:Organization
Organization Name:TERRY R. RICHMOND, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-476-6894
Mailing Address - Street 1:2999 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7393
Mailing Address - Country:US
Mailing Address - Phone:850-476-6894
Mailing Address - Fax:850-476-2676
Practice Address - Street 1:2999 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7393
Practice Address - Country:US
Practice Address - Phone:850-476-6894
Practice Address - Fax:850-476-2676
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERRY R. RICHMOND, DDS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL113461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty