Basic Information
| Provider Information | |||||||||
| NPI: | 1053398958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | H | ||||||||
| MiddleName: | LAWRENCE | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 SHENANGO AVE | ||||||||
| Address2: | |||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161461503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247048886 | ||||||||
| FaxNumber: | 7243421942 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 SHARON NEW CASTLE RD | ||||||||
| Address2: | |||||||||
| City: | FARRELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161211576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249811721 | ||||||||
| FaxNumber: | 7249817025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 07/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DS015487L | PA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 00093163200002 | 05 | PA | MEDICAID | 0016342 | 05 | OH | MEDICAID |