Healthcare Provider Details

I. General information

NPI: 1548230022
Provider Name (Legal Business Name): A. K. RICHARDSON AND ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 EASTWAY DR SUITE 10
CHARLOTTE NC
28205-5670
US

IV. Provider business mailing address

PO BOX 860036
MINNEAPOLIS MN
55486-0036
US

V. Phone/Fax

Practice location:
  • Phone: 704-563-5327
  • Fax: 216-584-1107
Mailing address:
  • Phone: 704-563-5327
  • Fax: 216-584-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHEL NITTINGER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 972-755-0816