Provider Demographics
NPI:1194905034
Name:RICH, ALAN BREWSTER JR (DMD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BREWSTER
Last Name:RICH
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 PLEASANT AVE
Mailing Address - Street 2:SUITE 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:SUITE 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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist