Richardson, Jacquelyn L
Richardson, Jacquelyn L is an sole proprietor health care provider with primary practice located at 609 35Th Ave Ste 3 , Moline IL 61265-6146. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Richardson, Jacquelyn L can be contacted via phone (309) 762-3015.Contact Information
Primary practice address
609 35Th Ave Ste 3
Moline IL 61265-6146
Phone: (309) 762-3015
Fax: (309) 762-1461
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 019-026572 | Illinois |
Profile Details
| NPI number | 1780853366 |
|---|---|
| LBN Legal business name | Richardson, Jacquelyn L |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 27th, 2008 |
| Last updated | Aug 20th, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780853366 | NPPES |
| Illinois | MEDICAID | 9182564 |
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