Provider Demographics
NPI:1144604703
Name:RICCARDI, NANCY ALEXANDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ALEXANDRA
Last Name:RICCARDI
Suffix:
Gender:F
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:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-0336
Mailing Address - Country:US
Mailing Address - Phone:229-924-2224
Mailing Address - Fax:229-924-4452
Practice Address - Street 1:1106 FETNER DR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3774
Practice Address - Country:US
Practice Address - Phone:229-924-2224
Practice Address - Fax:229-924-4452
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist