MEDICARE: NOELIA I RICHARDSON DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	061478	NY

General Provider Information

NPI Number	:	1376014886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOELIA I RICHARDSON DDS

Provider Business Mailing Address
First Line	:	760 BROADWAY
Second Line	:	DENTAL CLINIC
City	:	BROOKLYN
State	:	NY
Zip	:	11206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-5317
Country	:	US
Telephone Number	:	718-963-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	03/10/2026

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