Provider Demographics
NPI:1376695882
Name:RICH, ADAM KENDALL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:KENDALL
Last Name:RICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-9406
Mailing Address - Country:US
Mailing Address - Phone:601-400-1030
Mailing Address - Fax:859-824-7134
Practice Address - Street 1:139 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-9406
Practice Address - Country:US
Practice Address - Phone:601-400-1030
Practice Address - Fax:859-824-7134
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY77301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice