Provider Demographics
NPI:1447505805
Name:RICH, COLTON (DMD)
Entity type:Individual
Prefix:DR
First Name:COLTON
Middle Name:
Last Name:RICH
Suffix:
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 1:1223 E FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3937
Mailing Address - Country:US
Mailing Address - Phone:801-836-0178
Mailing Address - Fax:
Practice Address - Street 1:7700 W ARROWHEAD TOWNE CTR STE 2268
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8654
Practice Address - Country:US
Practice Address - Phone:623-937-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ84161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice