Provider Demographics
NPI:1104935816
Name:RICHARDSON, EMMETT VYNSTON III (DDS)
Entity type:Individual
Prefix:DR
First Name:EMMETT
Middle Name:VYNSTON
Last Name:RICHARDSON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4223
Mailing Address - Country:US
Mailing Address - Phone:276-783-4442
Mailing Address - Fax:276-783-9270
Practice Address - Street 1:635 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4223
Practice Address - Country:US
Practice Address - Phone:276-783-4442
Practice Address - Fax:276-783-9270
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010071391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice