Provider Demographics
NPI:1013244839
Name:JURY, RICHARD (RDH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:JURY
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:WA
Mailing Address - Zip Code:99173-0429
Mailing Address - Country:US
Mailing Address - Phone:509-258-7543
Mailing Address - Fax:509-258-7524
Practice Address - Street 1:105 N. 2ND STREET
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:WA
Practice Address - Zip Code:99173
Practice Address - Country:US
Practice Address - Phone:509-258-7543
Practice Address - Fax:509-258-7524
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00004168124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist