MEDICARE: DR. KIMBERLY ANN RICHARDS DDS

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	048302	NY

General Provider Information

NPI Number	:	1588677041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ANN RICHARDS DDS

Provider Business Mailing Address
First Line	:	4415 BUFFALO RD
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1024
Country	:	US
Telephone Number	:	585-594-9177
Fax Number	:	585-594-9434

Provider Business Practice Location Address
First Line	:	4415 BUFFALO RD
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1024
Country	:	US
Telephone Number	:	585-594-9177
Fax Number	:	585-594-9434

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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