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General NPI Number Information
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NPI Number | 1225333172
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Entity Type | Organization
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Legal Business Name | RICHARDSON AND LUNN COSMETIC AND FAMILY DENTISRTY
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Dates
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Enumeration Date | 01/24/2011
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 1525 HERITAGE LANE
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City | FLORENCE
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State | SC
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Zip | 29505-3141
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Country | US
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Telephone | 843-662-3505
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Fax | 843-662-3722
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Provider Business Mailing Address
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Address Line | 1525 HERITAGE LN
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City | FLORENCE
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State | SC
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Zip | 29505-3141
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Country | US
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Telephone | 843-662-3505
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Fax | 843-662-3722
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GINGER GRAY
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Credential |
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Telephone | 843-662-3505
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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 | 4047
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2753
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License Number State | SC
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