Healthcare Provider Details

I. General information

NPI: 1457770026
Provider Name (Legal Business Name): MICHAEL RAY RICHARDS D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 N 2000 W
FARR WEST UT
84404-9541
US

IV. Provider business mailing address

1761 N 2000 W
FARR WEST UT
84404-9541
US

V. Phone/Fax

Practice location:
  • Phone: 801-731-4850
  • Fax:
Mailing address:
  • Phone: 801-731-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8718587-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: