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General NPI Number Information
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NPI Number | 1184894404
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Entity Type | Organization
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Legal Business Name | DR. EUGENE A. RICHARDSON III
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 23 SHORE ST
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City | PETERSBURG
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State | VA
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Zip | 23803-5818
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Country | US
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Telephone | 804-861-5331
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Fax | 804-861-5351
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Provider Business Mailing Address
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Address Line | 23 SHORE ST
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City | PETERSBURG
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State | VA
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Zip | 23803-5818
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Country | US
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Telephone | 804-861-5331
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Fax | 804-861-5351
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EUGENE ARTHUR RICHARDSON III
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Credential |
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Telephone | 804-861-5330
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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 | 0401005258
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License Number State | VA
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