Healthcare Provider Details

I. General information

NPI: 1629090923
Provider Name (Legal Business Name): MARY ANNE RICHMOND D.M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 TAMARACK CIR
SKILLMAN NJ
08558-2019
US

IV. Provider business mailing address

29 SOUTHERN HILLS DR
SKILLMAN NJ
08558-2355
US

V. Phone/Fax

Practice location:
  • Phone: 609-688-1611
  • Fax: 609-688-8309
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDI19889
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: