Healthcare Provider Details

I. General information

NPI: 1285968693
Provider Name (Legal Business Name): CLAUDIA ANN RICHTER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12635 W RUDASILL RD
TUCSON AZ
85743-9724
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-682-3777
  • Fax: 520-682-2333
Mailing address:
  • Phone: 520-682-4560
  • Fax: 520-682-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH6663
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: