Provider Demographics
NPI:1407875156
Name:RICHEY, JAMES C
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:RICHEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1603
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-1603
Mailing Address - Country:US
Mailing Address - Phone:337-783-3321
Mailing Address - Fax:
Practice Address - Street 1:117 BLUE LAKE DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2356
Practice Address - Country:US
Practice Address - Phone:337-783-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice