MEDICARE: DR. WILLIAM S RICH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12551	MI

General Provider Information

NPI Number	:	1669675252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM S RICH DDS

Provider Business Mailing Address
First Line	:	3326 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-3627
Country	:	US
Telephone Number	:	313-381-0343
Fax Number	:	313-386-0331

Provider Business Practice Location Address
First Line	:	3326 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-3627
Country	:	US
Telephone Number	:	313-381-0343
Fax Number	:	313-386-0331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2007
Last Update Date	:	07/08/2007

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