Provider Demographics
NPI:1881205219
Name:ALAN B. RICH, JR. DMD PA
Entity type:Organization
Organization Name:ALAN B. RICH, JR. DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-771-2093
Mailing Address - Street 1:163 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3242
Mailing Address - Country:US
Mailing Address - Phone:207-771-2093
Mailing Address - Fax:
Practice Address - Street 1:163 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3242
Practice Address - Country:US
Practice Address - Phone:207-771-2093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty