Provider Demographics
NPI:1548254345
Name:RICHARDS, JONATHAN FIFE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:FIFE
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 W HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6839
Mailing Address - Country:US
Mailing Address - Phone:952-201-3643
Mailing Address - Fax:
Practice Address - Street 1:5991 S 3500 W
Practice Address - Street 2:SUITE 200
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-6701
Practice Address - Country:US
Practice Address - Phone:801-779-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5348402-99221223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice