Healthcare Provider Details

I. General information

NPI: 1992997159
Provider Name (Legal Business Name): RODNEY C RICHARDSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 24TH AVE
MERIDIAN MS
39301-3112
US

IV. Provider business mailing address

1609 24TH AVE
MERIDIAN MS
39301-3112
US

V. Phone/Fax

Practice location:
  • Phone: 601-693-6362
  • Fax: 601-483-8730
Mailing address:
  • Phone: 601-693-6362
  • Fax: 601-483-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2427-88
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: