=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093822892
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA A RICHMAN DDS MSD MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 12/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17265 SE WAX RD STE 103
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-9102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-220-7345
-----------------------------------------------------
Fax | 253-248-0162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17265 SE WAX RD STE 103
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-9102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-220-7345
-----------------------------------------------------
Fax | 253-248-0162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DE60069948
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------