Provider Demographics
NPI:1063525822
Name:RICH, MARTHA ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:RICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SW 11TH AVE
Mailing Address - Street 2:STE 405
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2118
Mailing Address - Country:US
Mailing Address - Phone:503-228-6870
Mailing Address - Fax:503-222-7189
Practice Address - Street 1:833 SW 11TH AVE
Practice Address - Street 2:STE 405
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2118
Practice Address - Country:US
Practice Address - Phone:503-228-6870
Practice Address - Fax:503-222-7189
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD5803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist