Provider Demographics
NPI:1548346521
Name:RICHARDSON, GARY DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:DEAN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:9453 CANYON HOLLOW AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0120
Mailing Address - Country:US
Mailing Address - Phone:702-838-5437
Mailing Address - Fax:702-838-5434
Practice Address - Street 1:8995 W FLAMINGO RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-0441
Practice Address - Country:US
Practice Address - Phone:702-838-5437
Practice Address - Fax:702-838-5434
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVS6-491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry