Provider Demographics
NPI:1144341108
Name:RICKARD, PAUL V (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:V
Last Name:RICKARD
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:DENTAL ASSOCIATES
Mailing Address - Street 2:505 E JOHNSON STREET
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935
Mailing Address - Country:US
Mailing Address - Phone:920-924-9090
Mailing Address - Fax:414-808-3098
Practice Address - Street 1:DENTAL ASSOCIATES
Practice Address - Street 2:545 E JOHNSON STREET
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935
Practice Address - Country:US
Practice Address - Phone:920-924-9090
Practice Address - Fax:414-808-3031
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001682-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice