Healthcare Provider Details

I. General information

NPI: 1376695882
Provider Name (Legal Business Name): ADAM KENDALL RICH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
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
DRY RIDGE KY
41035-9406
US

V. Phone/Fax

Practice location:
  • Phone: 601-400-1030
  • Fax: 859-824-7134
Mailing address:
  • Phone: 601-400-1030
  • Fax: 859-824-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7730
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: