Healthcare Provider Details

I. General information

NPI: 1063262608
Provider Name (Legal Business Name): TAKARA LEIGH RICHARD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MAPLEVILLE DEPOT
SAINT ALBANS VT
05478-1857
US

IV. Provider business mailing address

71 E REDROCK DR APT 105
BURLINGTON VT
05401-6013
US

V. Phone/Fax

Practice location:
  • Phone: 802-527-1227
  • Fax:
Mailing address:
  • Phone: 484-681-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016.0134425
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: