Individual
LACEY RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3326 4TH ST STE 1, LEWISTON, ID 83501-4455
(208) 746-2646
Mailing address
726 PRESTON AVE, LEWISTON, ID 83501-4619
(208) 790-6575
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH-3647-RST
ID
Other
Enumeration date
04/27/2021
Last updated
04/27/2021
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