Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 18715 | OH |
NPI | 1013139492 |
---|---|
Provider Name | Dr. Lisa Anne Richards |
First Address | Willoughby, OH 44094-5631 |
Second Address | Willoughby, OH 44094-5631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0699856 | (05) | OH |