MEDICARE: HARRY ED RICHARDS D.M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS022430L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	135702	OTHER	PA	UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	71016	OTHER	PA	GEISINGER

General Provider Information

NPI Number	:	1821050527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRY ED RICHARDS D.M.D.

Provider Business Mailing Address
First Line	:	121 MAIN ST
Second Line	:
City	:	BROOKVILLE
State	:	PA
Zip	:	15825-1212
Country	:	US
Telephone Number	:	814-849-3400
Fax Number	:	814-849-5522

Provider Business Practice Location Address
First Line	:	121 MAIN ST
Second Line	:
City	:	BROOKVILLE
State	:	PA
Zip	:	15825-1212
Country	:	US
Telephone Number	:	814-849-3400
Fax Number	:	814-849-5522

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	10/18/2011

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