Individual
KORI MARIE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
57250 ALPHA DR, GOSHEN, IN 46528-7804
(574) 875-3817
Mailing address
50782 COBBLESTONE DR, GRANGER, IN 46530-1309
(574) 220-2859
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13008766A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13008766A
DENTAL HYGIENE LICENSE NUMBER
IN
Enumeration date
06/25/2021
Last updated
06/25/2021
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