MEDICARE: DR. ROGER W RICHARDSON DMD

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	1223G0001X	General Practice Dentistry	5862	KY

General Provider Information

NPI Number	:	1306825583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER W RICHARDSON DMD

Provider Business Mailing Address
First Line	:	185 OAKBROOKE CIRCLE
Second Line	:	SUITE 1
City	:	MT. WASHINGTON
State	:	KY
Zip	:	40047
Country	:	US
Telephone Number	:	502-538-0363
Fax Number	:	502-538-0362

Provider Business Practice Location Address
First Line	:	185 OAKBROOKE CIRCLE
Second Line	:	SUITE 1
City	:	MT. WASHINGTON
State	:	KY
Zip	:	40047
Country	:	US
Telephone Number	:	502-538-0363
Fax Number	:	502-538-0362

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	10/21/2014

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