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General NPI Number Information
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NPI Number | 1770085375
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Entity Type | Organization
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Legal Business Name | BEVAN RICHARDSON
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 851 OAK LN
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City | RIO LINDA
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State | CA
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Zip | 95673-2341
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Country | US
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Telephone | 916-991-6402
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Fax | 916-991-7297
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Provider Business Mailing Address
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Address Line | 851 OAK LN
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City | RIO LINDA
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State | CA
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Zip | 95673-2341
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Country | US
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Telephone | 916-991-6402
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Fax | 916-991-7297
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | RENEE DAVIDSON
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Credential |
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Telephone | 916-991-6402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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