Provider Demographics
NPI:1417030321
Name:FERRICK, REED C (DMD)
Entity Type:Individual
Prefix:DR
First Name:REED
Middle Name:C
Last Name:FERRICK
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 1:3750 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5215
Mailing Address - Country:US
Mailing Address - Phone:707-542-6772
Mailing Address - Fax:707-542-5939
Practice Address - Street 1:3750 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5215
Practice Address - Country:US
Practice Address - Phone:707-542-6772
Practice Address - Fax:707-542-5939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA337601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice