MEDICARE: RICHMOND SMILE DESIGNS, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1255180253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND SMILE DESIGNS, LLC

Provider Business Mailing Address
First Line	:	311 RADIO PARK DR STE B
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2399
Country	:	US
Telephone Number	:	859-623-3818
Fax Number	:	859-624-1061

Provider Business Practice Location Address
First Line	:	311 RADIO PARK DR STE B
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2399
Country	:	US
Telephone Number	:	859-623-3818
Fax Number	:	859-624-1061

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MELANIE CALITRI
Credential	:
Telephone Number	:	859-623-3818

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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