Healthcare Provider Details

I. General information

NPI: 1609707959
Provider Name (Legal Business Name): WILLIAM JEFFERY RICHBURG II DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MANNSDALE VILLAGE DR
MADISON MS
39110-1213
US

IV. Provider business mailing address

105 OWEN ST
MADISON MS
39110-4554
US

V. Phone/Fax

Practice location:
  • Phone: 769-300-5902
  • Fax:
Mailing address:
  • Phone: 601-862-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112655
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: