Provider Demographics
NPI:1992997159
Name:RICHARDSON, RODNEY C (DMD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:C
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3112
Mailing Address - Country:US
Mailing Address - Phone:601-693-6362
Mailing Address - Fax:601-483-8730
Practice Address - Street 1:1609 24TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3112
Practice Address - Country:US
Practice Address - Phone:601-693-6362
Practice Address - Fax:601-483-8730
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2427-881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics