Provider Demographics
NPI:1053670141
Name:PETER A. RICH, D.M.D. INC.
Entity Type:Organization
Organization Name:PETER A. RICH, D.M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-540-0816
Mailing Address - Street 1:15835 POMERADO ROAD
Mailing Address - Street 2:101
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15835 POMERADO ROAD
Practice Address - Street 2:101
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2042
Practice Address - Country:US
Practice Address - Phone:858-487-4727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57833261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental