Healthcare Provider Details

I. General information

NPI: 1295793743
Provider Name (Legal Business Name): WILLIAM EDWARD RICHARDSON II DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E PIONEER AVE STE 2
HOMER AK
99603-7688
US

IV. Provider business mailing address

412 E PIONEER AVE STE 2
HOMER AK
99603-7688
US

V. Phone/Fax

Practice location:
  • Phone: 907-299-5778
  • Fax: 907-226-2310
Mailing address:
  • Phone: 907-299-5778
  • Fax: 907-226-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN16426
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1153
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: