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NPI Code Detail

MEDICARE: DR. JACQUELINE NICOLE RICHMOND D.D.S.

MEDICARE: DR. JACQUELINE NICOLE RICHMOND D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDEN.00203018CO

General Provider Information

NPI Number : 1023499597
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE NICOLE RICHMOND D.D.S.
Provider Business Mailing Address
First Line : 1560 MARKET ST APT 706
Second Line :
City : DENVER
State : CO
Zip : 80202-2466
Country : US
Telephone Number : 301-268-2605
Fax Number :
Provider Business Practice Location Address
First Line : 3705 E COLFAX AVE UNIT 101
Second Line :
City : DENVER
State : CO
Zip : 80206-1810
Country : US
Telephone Number : 303-399-3001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2015
Last Update Date : 07/21/2022

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