Healthcare Provider Details

I. General information

NPI: 1568493187
Provider Name (Legal Business Name): HARLEY MERCER RICHARDS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 HARDEN BLVD
LAKELAND FL
33803-5917
US

IV. Provider business mailing address

2150 HARDEN BLVD
LAKELAND FL
33803-5917
US

V. Phone/Fax

Practice location:
  • Phone: 863-665-8878
  • Fax: 863-665-1096
Mailing address:
  • Phone: 863-665-8878
  • Fax: 863-665-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDN 7401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: