MEDICARE: JONATHAN F. RICHARDS

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1093513889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN F. RICHARDS

Provider Business Mailing Address
First Line	:	5991 S 3500 W
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-6701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5991 S 3500 W
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-6701
Country	:	US
Telephone Number	:	801-779-2700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN F RICHARDS
Credential	:
Telephone Number	:	801-779-2700

Provider Enumeration Date	:	03/06/2025
Last Update Date	:	03/06/2025

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