Individual
DR. THOMAS LANE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD JD
Contact information
Practice address
1250 FOREST AVENUE, SUITE 3B, PORTLAND, ME 04103-1884
(202) 878-3480
(202) 878-3481
Mailing address
1250 FOREST AVENUE, SUITE 3B, PORTLAND, ME 04103-1884
(202) 878-3480
(202) 878-3481
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3228
ME
1223G0001X
General Practice Dentistry
517
AK
Other
Enumeration date
09/16/2006
Last updated
07/08/2007
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