Provider Demographics
NPI:1407848708
Name:RICKERBY, HAIG HERBERT DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAIG
Middle Name:HERBERT DANIEL
Last Name:RICKERBY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JOURNAL SQUARE PLZ
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4004
Mailing Address - Country:US
Mailing Address - Phone:201-656-2221
Mailing Address - Fax:201-656-6308
Practice Address - Street 1:1 JOURNAL SQUARE PLZ
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4004
Practice Address - Country:US
Practice Address - Phone:201-656-2221
Practice Address - Fax:201-656-6308
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ161641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice