Provider Demographics
NPI:1629227475
Name:RICHEY, JAMES KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNETH
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 1:115 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2464
Mailing Address - Country:US
Mailing Address - Phone:618-997-4514
Mailing Address - Fax:
Practice Address - Street 1:115 W UNION ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2464
Practice Address - Country:US
Practice Address - Phone:618-997-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist