Provider Demographics
NPI:1417186503
Name:AUTREY, RICK D (DDS)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:D
Last Name:AUTREY
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 1:4703 NE STALLINGS DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1607
Mailing Address - Country:US
Mailing Address - Phone:936-560-0698
Mailing Address - Fax:936-560-0846
Practice Address - Street 1:4703 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1607
Practice Address - Country:US
Practice Address - Phone:936-560-0698
Practice Address - Fax:936-560-0846
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist