Individual
DR. DANIEL THEODORE RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD MD
Contact information
Practice address
6865 DEERPATH RD, DORSEY STATION, SUITE 302, ELKRIDGE, MD 21075-6257
(410) 796-3333
(410) 796-3375
Mailing address
PO BOX 64767, BALTIMORE, MD 21264-4767
(410) 614-1732
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
14259
MD
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
14259
MD
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
D67181
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9219426
DORAL DENTAL
MD
Enumeration date
11/04/2005
Last updated
06/01/2011
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