Healthcare Provider Details

I. General information

NPI: 1083177257
Provider Name (Legal Business Name): ANDREW RICH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 DIABLO RD STE 101
DANVILLE CA
94526-3566
US

IV. Provider business mailing address

380 DIABLO RD STE 101
DANVILLE CA
94526-3566
US

V. Phone/Fax

Practice location:
  • Phone: 925-269-8626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number103152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: