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General NPI Number Information
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NPI Number | 1720206527
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Entity Type | Individual
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Provider Name | TEHEMINA GAGRAT RICHARDSON DDS
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 1460 N HALSTED ST SUITE 403
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City | CHICAGO
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State | IL
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Zip | 60642-2605
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Country | US
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Telephone | 773-880-5455
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Fax |
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Provider Business Mailing Address
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Address Line | 101 S. WASHINGTON AVENUE SUITE 114
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City | PARK RIDGE
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State | IL
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Zip | 60068
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Country | US
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Telephone | 847-698-2088
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Fax | 847-698-2091
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019.026876
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License Number State | IL
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