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Individual

JAKE RICHARDSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
6932 E 1400 S, FORT DUCHESNE, UT 84026
(435) 722-5122
Mailing address
412 E 2500 N, VERNAL, UT 84078-9595
(435) 828-8801

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11308205-9921
UT

Other

Enumeration date
07/02/2019
Last updated
07/02/2019
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