Provider Demographics
NPI:1104098730
Name:PETER N. RICHARDS, D.D.S., P.C.
Entity type:Organization
Organization Name:PETER N. RICHARDS, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:N
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-289-6454
Mailing Address - Street 1:4324 COVINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1208
Mailing Address - Country:US
Mailing Address - Phone:404-289-6454
Mailing Address - Fax:404-289-2570
Practice Address - Street 1:4324 COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1208
Practice Address - Country:US
Practice Address - Phone:404-289-6454
Practice Address - Fax:404-289-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty