Healthcare Provider Details

I. General information

NPI: 1376014886
Provider Name (Legal Business Name): NOELIA I RICHARDSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

760 BROADWAY DENTAL CLINIC
BROOKLYN NY
11206
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number061478
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: