Jacquelyn L Richardson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019-026572 Issued in IL

Practice address

609 35TH Ave Ste 3
Moline, IL 61265-6146

Phone

(309) 762-3015

Fax

(309) 762-1461

NPI assigned

Feb 27, 2008

Last updated

Aug 20, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hawkeye Dental Creations

  dba Total Health Dentistry

  • General Practice Dentistry
  • Moline, IL
  • NPI 1649305921
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408492800000",
    "number": "1780853366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 35TH AVE STE 3",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656146",
            "telephone_number": "309-762-3015",
            "fax_number": "309-762-1461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 35TH AVE STE 3",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656146",
            "telephone_number": "309-762-3015",
            "fax_number": "309-762-1461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "JACQUELYN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-27",
        "last_updated": "2014-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-026572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9182564",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Rheingans, PT
• Temia Rice
• Brian J Richards, D.D.S.
• Melvin J. Richards, M.D.
• Michael Donald Richards, D.C.
• Elizabeth Richmiller, APRN
• Kasey Riesberg, D.C.
• Ronald Dale Riggins, D.M.D.
• Lonnie L Rinell, DC
• Chloe Frances Rittenhouse

• Dentist in Moline, IL
• Providers in Moline, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2014; 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.

Verify at the official NPI Registry.