Provider Demographics
NPI:1518057850
Name:RICH, JEFFREY JONATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JONATHAN
Last Name:RICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8402 HARCOURT ROAD
Mailing Address - Street 2:SUITE 625
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-872-3465
Mailing Address - Fax:317-872-4340
Practice Address - Street 1:8402 HARCOURT ROAD
Practice Address - Street 2:SUITE 625
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-872-3465
Practice Address - Fax:317-872-4340
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ6838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist