1174580658 NPI number — DR. KARL RANDY RICHARDS D.D.S.

Table of content: DR. KARL RANDY RICHARDS D.D.S. (NPI 1174580658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174580658 NPI number — DR. KARL RANDY RICHARDS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDS
Provider First Name:
KARL
Provider Middle Name:
RANDY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174580658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
US ARMY DENTAL COMMAND
Provider Second Line Business Mailing Address:
2240 E. WINROW AVE
Provider Business Mailing Address City Name:
FORT HUACHUCA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-533-3147
Provider Business Mailing Address Fax Number:
520-533-5046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US ARMY DENTAL COMMAND
Provider Second Line Business Practice Location Address:
2240 E. WINROW AVE
Provider Business Practice Location Address City Name:
FORT HUACHUCA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-533-3147
Provider Business Practice Location Address Fax Number:
520-533-5046
Provider Enumeration Date:
04/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D-3601 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0700X , with the licence number: D-3601 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)