Active NPI
Bruce W Richardson, D.D.S.
- Periodontics
- Meridian, ID
National Provider Identifier
1306959424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- D3443PE
- Practice address
- 317 W Cherry LN
Meridian, ID 83642-1608 - Phone
- (208) 888-2055
- NPI assigned
- Aug 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | D3443PE | ID | Primary |
Addresses
Primary practice location
317 W Cherry LN
Meridian, ID 83642-1608
Mailing address
3171 W Deerfield CT
Eagle, ID 83616-2343
Phone (208) 841-9009
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160627000750 | ID | Order and Referring Only - Dentist | 5799076584 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-4579 | ID | MD | Dentist |
| D3443PE | ID | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306959424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3171 W DEERFIELD CT",
"city": "EAGLE",
"state": "ID",
"postal_code": "836162343",
"telephone_number": "208-841-9009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 W CHERRY LN",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421608",
"telephone_number": "208-888-2055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "BRUCE",
"middle_name": "W",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "ID",
"license": "D3443PE",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.