Provider Demographics
NPI:1114760949
Name:RICHARDSON, HALEY (DDS)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 SHADY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4159
Mailing Address - Country:US
Mailing Address - Phone:870-310-7570
Mailing Address - Fax:
Practice Address - Street 1:225 N NEWTON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5421
Practice Address - Country:US
Practice Address - Phone:870-864-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR47611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice