Provider Demographics
NPI:1699241216
Name:RICH, CANDACE JANE (DDS)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:JANE
Last Name:RICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 S PAXTON DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-6404
Mailing Address - Country:US
Mailing Address - Phone:574-267-6571
Mailing Address - Fax:
Practice Address - Street 1:220 DEAN JOHNSON BLVD RM 184
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-3415
Practice Address - Country:US
Practice Address - Phone:888-489-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009776A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist