Provider Demographics
NPI:1588125454
Name:RICHARDSON, KATHERINE NICOLE (MS, DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:NICOLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS, DDS
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3600 FORBES AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3410
Mailing Address - Country:US
Mailing Address - Phone:512-659-0814
Mailing Address - Fax:
Practice Address - Street 1:3501 TERRACE STREET G-32 SALK HALL
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-7001
Practice Address - Country:US
Practice Address - Phone:412-648-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103241223S0112X
TX354841223S0112X
PADS0427161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100651090Medicaid