Individual
BRUCE W RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
317 W CHERRY LN, MERIDIAN, ID 83642-1608
(208) 888-2055
Mailing address
3171 W DEERFIELD CT, EAGLE, ID 83616-2343
(208) 841-9009
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D3443PE
ID
Other
Enumeration date
08/15/2006
Last updated
07/08/2007
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