Healthcare Provider Details

I. General information

NPI: 1013617356
Provider Name (Legal Business Name): DENNIS JOHN RICHARDS II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 ROOSEVELT AVE
SAN ANTONIO TX
78214-2832
US

IV. Provider business mailing address

5039 HAMILTON WOLFE RD
SAN ANTONIO TX
78229-4456
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-3232
  • Fax: 210-932-2168
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40446
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: