Provider Demographics
NPI:1770694150
Name:RICHARDSON, MICHEAL L (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314
Mailing Address - Country:US
Mailing Address - Phone:304-744-9717
Mailing Address - Fax:304-744-9733
Practice Address - Street 1:1013 BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314
Practice Address - Country:US
Practice Address - Phone:304-744-9717
Practice Address - Fax:304-744-9733
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice