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General NPI Number Information
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NPI Number | 1033509435
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Entity Type | Organization
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Legal Business Name | JOHN V.D. RICHARDSON, DDS., INC
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 1409 WHITLEY AVE SUITE D
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City | CORCORAN
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State | CA
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Zip | 93212-2223
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Country | US
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Telephone | 559-992-4138
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Fax | 559-992-4079
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Provider Business Mailing Address
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Address Line | 1409 WHITLEY AVE SUITE D
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City | CORCORAN
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State | CA
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Zip | 93212-2223
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Country | US
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Telephone | 559-992-4138
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Fax | 559-992-4079
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN VERNON DALE RICHARDSON
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Credential | DDS.
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Telephone | 559-992-4138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 39700
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License Number State | CA
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