Healthcare Provider Details

I. General information

NPI: 1235157785
Provider Name (Legal Business Name): STEVEN MARK RICHMOND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 RIDGE AVE
PHILADELPHIA PA
19128-2446
US

IV. Provider business mailing address

6801 RIDGE AVE
PHILADELPHIA PA
19128-2446
US

V. Phone/Fax

Practice location:
  • Phone: 215-483-6633
  • Fax: 215-483-7909
Mailing address:
  • Phone: 215-483-6633
  • Fax: 215-483-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS021569L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: