MEDICARE: MRS. ELIZABETH ANN RICHARDSON RDH

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	124Q00000X	Dental Hygienist	1929	TX

General Provider Information

NPI Number	:	1376514570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN RICHARDSON RDH

Provider Business Mailing Address
First Line	:	3102 NE MAYFLOWER AVE
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73507-3456
Country	:	US
Telephone Number	:	580-351-0317
Fax Number	:

Provider Business Practice Location Address
First Line	:	2776 RINGGOLD RD
Second Line	:
City	:	FT. SILL
State	:	OK
Zip	:	73503
Country	:	US
Telephone Number	:	580-442-3315
Fax Number	:

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/08/2007

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