Healthcare Provider Details

I. General information

NPI: 1801859905
Provider Name (Legal Business Name): DARIUS A RICHARDSON ORAL SURGEON
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 9095
FPO AP
96538
UM

IV. Provider business mailing address

BOX 9095
FPO AP
96538
UM

V. Phone/Fax

Practice location:
  • Phone: 671-344-9679
  • Fax: 671-344-9305
Mailing address:
  • Phone: 671-344-9679
  • Fax: 671-344-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD989
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: