Provider Demographics
NPI:1356506125
Name:PUCKETT, RICK DEAN (CPED)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:DEAN
Last Name:PUCKETT
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:377 S SWING RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2009
Mailing Address - Country:US
Mailing Address - Phone:336-316-1166
Mailing Address - Fax:336-316-1144
Practice Address - Street 1:377 S SWING RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2009
Practice Address - Country:US
Practice Address - Phone:336-316-1166
Practice Address - Fax:336-316-1144
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier