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General NPI Number Information
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NPI Number | 1538282074
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Entity Type | Organization
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Legal Business Name | K.A. RICHARDT DDS A PROFESSIONAL CORP
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 307 EAST BUENA VISTA STREET
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City | BARSTOW
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State | CA
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Zip | 92311-1052
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Country | US
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Telephone | 760-256-7777
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Fax | 760-256-1899
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Provider Business Mailing Address
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Address Line | P.O. BOX 10 307 EAST BUENA VISTA STREET
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City | BARSTOW
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State | CA
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Zip | 92311-1052
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Country | US
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Telephone | 760-256-7777
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Fax | 760-256-1899
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN ANN RICHARDT
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Credential | DDS
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Telephone | 760-256-7777
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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 | B34410
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License Number State | CA
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