Individual
DR. JACK MELVIN RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
15 SW 20TH AVENUE, BATTLE GROUND, WA 98604
(360) 687-5665
(360) 687-5053
Mailing address
PO BOX 157, 15 SW 20TH AVENUE, BATTLE GROUND, WA 98604-0157
(360) 687-5665
(360) 687-5053
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7107
WA
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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