Individual
DR. JACQUELYN L RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
609 35TH AVE STE 3, MOLINE, IL 61265-6146
(309) 762-3015
(309) 762-1461
Mailing address
609 35TH AVE STE 3, MOLINE, IL 61265-6146
(309) 762-3015
(309) 762-1461
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-026572
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9182564
—
IL
Enumeration date
02/27/2008
Last updated
08/20/2014
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