MEDICARE: JOHN D RICHARDSON II FAMILY DENTISTRY PA

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1922614916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D RICHARDSON II FAMILY DENTISTRY PA

Provider Business Mailing Address
First Line	:	421 SW 2ND ST
Second Line	:
City	:	CORNING
State	:	AR
Zip	:	72422-2708
Country	:	US
Telephone Number	:	870-857-0045
Fax Number	:	870-857-0051

Provider Business Practice Location Address
First Line	:	421 SW 2ND ST
Second Line	:
City	:	CORNING
State	:	AR
Zip	:	72422-2708
Country	:	US
Telephone Number	:	870-857-0045
Fax Number	:	870-857-0051

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	JOHN D RICHARDSON II
Credential	:	DDS
Telephone Number	:	870-857-0045

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	09/16/2020

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