MEDICARE: JOHN PERRY RICH III D.D.S.

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	1223G0001X	General Practice Dentistry	668673-8903	UT

General Provider Information

NPI Number	:	1871749135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PERRY RICH III D.D.S.

Provider Business Mailing Address
First Line	:	7086 S HIGHLAND DR STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3768
Country	:	US
Telephone Number	:	801-942-5520
Fax Number	:

Provider Business Practice Location Address
First Line	:	7086 S HIGHLAND DR STE 100
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3768
Country	:	US
Telephone Number	:	801-942-5520
Fax Number	:

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

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	11/28/2018

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