Provider Demographics
NPI:1083954945
Name:RICARDEZ, JORGE M (DDS)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:M
Last Name:RICARDEZ
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 1:2330 NE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3579
Mailing Address - Country:US
Mailing Address - Phone:954-563-5535
Mailing Address - Fax:954-563-8888
Practice Address - Street 1:2330 NE 9TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3579
Practice Address - Country:US
Practice Address - Phone:954-563-5535
Practice Address - Fax:954-563-8888
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 11679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist