Provider Demographics
NPI:1629147681
Name:RICHEY, SAM B (DDS)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:B
Last Name:RICHEY
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 1:3926 W. 13400 S.
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:80465
Mailing Address - Country:US
Mailing Address - Phone:801-446-6310
Mailing Address - Fax:801-446-5273
Practice Address - Street 1:3926 W. 13400 S.
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:80465
Practice Address - Country:US
Practice Address - Phone:801-446-6310
Practice Address - Fax:801-446-5273
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275870-9923122300000X
IDD-3584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist