| Organization Name: | RICHFIELD PEDIATRIC DENTISTRY, P.A. |
| NPI Number: | 1063752483 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAYLOR J STEPHENS (PRESIDENT/OWNER) |
| Mailing Address: | 6945 Penn Ave S Suite 102 Richfield |
| State: | MN US |
| Postal Code: | 554232081 |
| Phone Number: | 6128664041 |
| Fax Number: | |
| NPI Enumeration Date: | 02/21/2013 |
| NPI Last Update Date: | 01/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D12818 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |