Provider Demographics
NPI:1215155072
Name:RICHARDSON, AILEEN LOU (RDH)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:LOU
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37522 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:623-742-7993
Mailing Address - Fax:480-421-0115
Practice Address - Street 1:3226 N MILLER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-421-0113
Practice Address - Fax:480-421-0113
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2383124Q00000X
CARDH 15685124Q00000X
MA11562124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist