MEDICARE: STEVEN D 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	4865	OR

General Provider Information

NPI Number	:	1669575882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN D RICHARDSON DMD

Provider Business Mailing Address
First Line	:	1835 OCEAN BLVD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420
Country	:	US
Telephone Number	:	541-269-0620
Fax Number	:	541-269-9243

Provider Business Practice Location Address
First Line	:	1835 OCEAN BLVD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420
Country	:	US
Telephone Number	:	541-269-0620
Fax Number	:	541-269-9243

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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