Healthcare Provider Details

I. General information

NPI: 1790944320
Provider Name (Legal Business Name): CORY D RICHARDS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GERMANY DHA-RP 402 CMR UNIT 33100
APO AE
09180
US

IV. Provider business mailing address

FLUGPLATZ ERBENHEIM 1040
WIESBADEN HESSEN
65205
DE

V. Phone/Fax

Practice location:
  • Phone: 314-590-7163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD3533
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD3533
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: