Healthcare Provider Details

I. General information

NPI: 1285764480
Provider Name (Legal Business Name): RICHARDSON L MCGUIRE D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/21/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 N. MOPAC EXPRESSWAY BUILDING 2 SUITE 2207
AUSTIN TX
78731-3286
US

IV. Provider business mailing address

6500 N. MOPAC EXPRESSWAY BLDG 2 SUITE 2207
AUSTIN TX
78731-3286
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-7668
  • Fax: 512-452-7663
Mailing address:
  • Phone: 512-452-7668
  • Fax: 512-452-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22400
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: