Healthcare Provider Details

I. General information

NPI: 1548346521
Provider Name (Legal Business Name): GARY DEAN RICHARDSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8995 W FLAMINGO RD STE 100
LAS VEGAS NV
89147-0441
US

IV. Provider business mailing address

9453 CANYON HOLLOW AVE
LAS VEGAS NV
89149-0120
US

V. Phone/Fax

Practice location:
  • Phone: 702-838-5437
  • Fax: 702-838-5434
Mailing address:
  • Phone: 702-838-5437
  • Fax: 702-838-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-49
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: