MEDICARE: CLAUDIA ANN RICHTER RDH

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
1	124Q00000X	Dental Hygienist	H6663	AZ

General Provider Information

NPI Number	:	1285968693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA ANN RICHTER RDH

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-4560
Fax Number	:	520-682-4570

Provider Business Practice Location Address
First Line	:	12635 W RUDASILL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-9724
Country	:	US
Telephone Number	:	520-682-3777
Fax Number	:	520-682-2333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	10/01/2009

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