Healthcare Provider Details

I. General information

NPI: 1750573002
Provider Name (Legal Business Name): STEVEN L RICHARDSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2525 E ROOSEVELT ST
PHOENIX AZ
85008-4948
US

IV. Provider business mailing address

PO BOX 5177
PHOENIX AZ
85010-5177
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-1005
  • Fax:
Mailing address:
  • Phone: 602-344-5651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7324
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: