Individual
GLENN URBAN RICHEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
13826 HIGHWAY 12, OROFINO, ID 83544-9117
(208) 476-4413
(208) 476-4413
Mailing address
PO BOX 1009, OROFINO, ID 83544-1009
(208) 476-4413
(208) 476-4413
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1118
ID
Other
Enumeration date
06/23/2009
Last updated
06/23/2009
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