Provider Demographics
NPI:1790844082
Name:RICH, JEREMY S (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:S
Last Name:RICH
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S FRONT ST
Mailing Address - Street 2:APT 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:
Practice Address - Street 1:3554 HULMEVILLE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4366
Practice Address - Country:US
Practice Address - Phone:508-954-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics