Provider Demographics
NPI:1174972756
Name:RICHARDS, BRANDY (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:DR
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MSD
Mailing Address - Street 1:354 GEO LILES PKWY NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2403
Mailing Address - Country:US
Mailing Address - Phone:980-999-3186
Mailing Address - Fax:
Practice Address - Street 1:354 GEO LILES PKWY NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2403
Practice Address - Country:US
Practice Address - Phone:980-999-3186
Practice Address - Fax:980-999-3186
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC110981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry