Provider Demographics
NPI:1073724142
Name:RICCI, SHANE AUSTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:AUSTIN
Last Name:RICCI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10604 BLUE BAY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8574
Mailing Address - Country:US
Mailing Address - Phone:210-912-2985
Mailing Address - Fax:
Practice Address - Street 1:5132 VILLAGE CREEK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5064
Practice Address - Country:US
Practice Address - Phone:972-381-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00228841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice