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General NPI Number Information
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NPI Number | 1467114660
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Entity Type | Organization
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Legal Business Name | RICHMOND DENTAL CARE
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 8019 W GRAND PKWY S STE 1055
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City | RICHMOND
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State | TX
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Zip | 77407-1603
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Country | US
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Telephone | 832-595-2285
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Fax | 832-595-2293
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Provider Business Mailing Address
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Address Line | 1840 FM 359 RD
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City | RICHMOND
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State | TX
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Zip | 77406-2049
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Country | US
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Telephone | 832-595-2266
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN G FOSSUM
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Credential | DDS
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Telephone | 832-595-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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