Provider Demographics
NPI:1699965418
Name:RICHARDS, MELANIE (DMD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-9309
Mailing Address - Country:US
Mailing Address - Phone:864-220-5437
Mailing Address - Fax:864-220-0420
Practice Address - Street 1:10705 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-9309
Practice Address - Country:US
Practice Address - Phone:864-220-5437
Practice Address - Fax:864-220-0420
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
706109OtherUNITED CONCORDIA
SCZ31528Medicaid
3126152OtherBLUE CROSS BLUE SHIELD OF
880-09615OtherBLUE CROSS BLUE SHIELD OF