Provider Demographics
NPI:1194127811
Name:RICHEY FAMILY DENTISTRY
Entity type:Organization
Organization Name:RICHEY FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-232-7424
Mailing Address - Street 1:2499 E MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3342
Mailing Address - Country:US
Mailing Address - Phone:812-232-7424
Mailing Address - Fax:812-234-4324
Practice Address - Street 1:2499 E MARGARET DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3342
Practice Address - Country:US
Practice Address - Phone:812-232-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012114A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300065373Medicaid