Provider Demographics
NPI:1306245840
Name:HEATHER R RICHARDSON DMD MS
Entity type:Organization
Organization Name:HEATHER R RICHARDSON DMD MS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:303-721-1173
Mailing Address - Street 1:7384 S ALTON WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2369
Mailing Address - Country:US
Mailing Address - Phone:030-721-1173
Mailing Address - Fax:303-721-1179
Practice Address - Street 1:7384 S ALTON WAY
Practice Address - Street 2:STE 101
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2369
Practice Address - Country:US
Practice Address - Phone:030-721-1173
Practice Address - Fax:303-721-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9476261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental