Healthcare Provider Details

I. General information

NPI: 1861483133
Provider Name (Legal Business Name): ANDREA RICHMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 WESTFORD ST
CARLISLE MA
01741-1506
US

IV. Provider business mailing address

PO BOX 576 18 WESTFORD ROAD
CARLISLE MA
01741-0576
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-7967
  • Fax: 978-369-1086
Mailing address:
  • Phone: 978-369-7967
  • Fax: 978-369-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13905
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: