Individual
GARRETT GLEN RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IPDH
Contact information
Practice address
716 STEVENS AVE, PORTLAND, ME 04103-2693
(207) 221-4747
Mailing address
268 PEASE RD, BUXTON, ME 04093-6522
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2747
ME
Other
Enumeration date
07/06/2021
Last updated
07/06/2021
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