Provider Demographics
NPI:1073527990
Name:RICKY L PRICE DDS PA
Entity Type:Organization
Organization Name:RICKY L PRICE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-238-9190
Mailing Address - Street 1:311 MERRIMAN AVE E
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-2945
Mailing Address - Country:US
Mailing Address - Phone:870-238-9190
Mailing Address - Fax:
Practice Address - Street 1:311 MERRIMAN AVE E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-2945
Practice Address - Country:US
Practice Address - Phone:870-238-9190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110222OtherUNITED CONCORDIA
AR58029OtherBLUE CROSS BLUE SHEILD