Healthcare Provider Details

I. General information

NPI: 1831169986
Provider Name (Legal Business Name): JOHN JAMES RICHTER III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAGEBRUSH ST
ISLETA NM
87022
US

IV. Provider business mailing address

1800 VALDEZ DR NE
ALBUQUERQUE NM
87112-4827
US

V. Phone/Fax

Practice location:
  • Phone: 505-869-4499
  • Fax:
Mailing address:
  • Phone: 505-291-9605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDD1961
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: