Provider Demographics
NPI:1174580658
Name:RICHARDS, KARL RANDY (DDS)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:RANDY
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY DENTAL COMMAND
Mailing Address - Street 2:2240 E. WINROW AVE
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613
Mailing Address - Country:US
Mailing Address - Phone:520-533-3147
Mailing Address - Fax:520-533-5046
Practice Address - Street 1:US ARMY DENTAL COMMAND
Practice Address - Street 2:2240 E. WINROW AVE
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613
Practice Address - Country:US
Practice Address - Phone:520-533-3147
Practice Address - Fax:520-533-5046
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-36011223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice