MEDICARE: GREGORY L. RICHARDSON DDS.MS.PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	5744	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033380423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY L. RICHARDSON DDS.MS.PA

Provider Business Mailing Address
First Line	:	2606 IRON GATE DR
Second Line	:	SUITE 101
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2573
Country	:	US
Telephone Number	:	910-452-7988
Fax Number	:	910-452-7932

Provider Business Practice Location Address
First Line	:	2606 IRON GATE DR
Second Line	:	SUITE 101
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2573
Country	:	US
Telephone Number	:	910-452-7988
Fax Number	:	910-452-7632

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY L RICHARDSON
Credential	:	DDS
Telephone Number	:	910-452-7988

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	03/13/2008

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