Individual
KELLY DIANE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
212 LINDEN DR, SUITE 150, WINCHESTER, VA 22601-2894
(337) 493-5163
(337) 439-5866
Mailing address
212 LINDEN DR, SUITE 150, WINCHESTER, VA 22601-2894
(337) 493-5163
(337) 439-5866
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401412717
VA
122300000X
Dentist
27594
TX
122300000X
Dentist
6038
LA
122300000X
Dentist
Primary
60563
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100456320Q
—
KS
05
—
1860387
—
LA
Enumeration date
06/23/2008
Last updated
06/26/2013
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