Healthcare Provider Details

I. General information

NPI: 1801091905
Provider Name (Legal Business Name): BRENDA K. RICHARDSON, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E JOPPA RD SUITE 106
TOWSON MD
21286-5418
US

IV. Provider business mailing address

515 E JOPPA RD SUITE 106
TOWSON MD
21286-5418
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-5700
  • Fax: 410-321-9573
Mailing address:
  • Phone: 410-321-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9938
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BRENDA K. RICHARDSON
Title or Position: OWNER
Credential:
Phone: 410-321-5700