Healthcare Provider Details

I. General information

NPI: 1053670141
Provider Name (Legal Business Name): PETER A. RICH, D.M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15835 POMERADO ROAD 101
POWAY CA
92064-2042
US

IV. Provider business mailing address

15835 POMERADO ROAD 101
POWAY CA
92064-2042
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-4727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number57833
License Number StateCA

VIII. Authorized Official

Name: DR. PETER A RICH
Title or Position: OWNER/DENTIST
Credential: D.M.D.
Phone: 619-540-0816