=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356626758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUE ELLEN RICHARDSON, DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2011
-----------------------------------------------------
Last Update Date | 07/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7000 FANNIN ST SUITE 1660
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-5400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-796-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7000 FANNIN ST SUITE 1660
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-5400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-796-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUE ELLEN RICHARDSON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 713-796-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12776
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------