Provider Demographics
NPI:1003933862
Name:HARRELL, RICKY EUGENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:EUGENE
Last Name:HARRELL
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 1:13849 LEGEND TRL
Mailing Address - Street 2:UNIT 103
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-8275
Mailing Address - Country:US
Mailing Address - Phone:303-469-0735
Mailing Address - Fax:
Practice Address - Street 1:13065 E 17TH PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7238
Practice Address - Country:US
Practice Address - Phone:303-724-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist