| Organization Name: | JOHN V.D. RICHARDSON, DDS., INC |
| NPI Number: | 1033509435 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN VERNON DALE RICHARDSON (PRESIDENT) |
| Mailing Address: | 1409 Whitley Ave Suite D Corcoran |
| State: | CA US |
| Postal Code: | 932122223 |
| Phone Number: | 5599924138 |
| Fax Number: | 5599924079 |
| NPI Enumeration Date: | 01/23/2015 |
| NPI Last Update Date: | 01/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 39700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |