Individual
MRS. SHANTA DIANNE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
8001 HILLSBOROUGH RD, SUITE L, ELLICOTT CITY, MD 21043-6876
(443) 574-8944
(443) 574-8947
Mailing address
8001 HILLSBOROUGH RD, SUITE L, ELLICOTT CITY, MD 21043-6876
(443) 574-8944
(443) 574-8947
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
21208
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0208469
—
MA
Enumeration date
02/13/2006
Last updated
09/28/2023
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