Provider Demographics
NPI:1558697201
Name:RICH ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:RICH ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-954-2348
Mailing Address - Street 1:22 S FRONT ST
Mailing Address - Street 2:305
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3354
Mailing Address - Country:US
Mailing Address - Phone:508-954-2348
Mailing Address - Fax:267-772-7665
Practice Address - Street 1:3554 HULMEVILLE RD
Practice Address - Street 2:110
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4366
Practice Address - Country:US
Practice Address - Phone:215-244-9505
Practice Address - Fax:215-244-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty