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General NPI Number Information
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NPI Number | 1164500377
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Entity Type | Individual
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Provider Name | MELODY MILLER RICHARDSON DDS
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 63 WEST 6TH ST
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City | PERU
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State | IN
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Zip | 46970-2134
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Country | US
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Telephone | 765-473-4109
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Fax |
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Provider Business Mailing Address
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Address Line | 63 WEST SIXTH ST
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City | PERU
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State | IN
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Zip | 46970-2134
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Country | US
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Telephone | 765-473-4109
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12009144A
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License Number State | IN
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