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General NPI Number Information
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NPI Number | 1225779663
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Entity Type | Individual
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Provider Name | JACQUELYN CAROLE RICHARDS
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 2 STILSON ST
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City | SANFORD
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State | ME
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Zip | 04073-3228
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Country | US
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Telephone | 207-324-8699
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Fax |
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Provider Business Mailing Address
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Address Line | 134 MIDDLE ST UNIT 5
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4354
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Country | US
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Telephone | 207-975-6068
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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 | DEN5046
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License Number State | ME
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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 | 50255
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License Number State | NH
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