Healthcare Provider Details

I. General information

NPI: 1679641005
Provider Name (Legal Business Name): WILLIAM KENDALL RICH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 S MAIN ST
DRY RIDGE KY
41035-9406
US

IV. Provider business mailing address

139 S MAIN ST PO BOX 238
DRY RIDGE KY
41035-9406
US

V. Phone/Fax

Practice location:
  • Phone: 859-824-7133
  • Fax: 859-824-7134
Mailing address:
  • Phone: 859-824-7133
  • Fax: 859-824-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4513
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: