Provider Demographics
NPI:1982958161
Name:RICHARDSON PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:RICHARDSON PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-574-8944
Mailing Address - Street 1:8001 HILLSBOROUGH RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6872
Mailing Address - Country:US
Mailing Address - Phone:443-574-8944
Mailing Address - Fax:443-574-8947
Practice Address - Street 1:8001 HILLSBOROUGH RD
Practice Address - Street 2:SUITE L
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6872
Practice Address - Country:US
Practice Address - Phone:443-574-8944
Practice Address - Fax:443-574-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty