Provider Demographics
NPI:1467896571
Name:RICKS, DALLEN BRYCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALLEN
Middle Name:BRYCE
Last Name:RICKS
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 1:2420 QUAKER AVE
Mailing Address - Street 2:104
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1817
Mailing Address - Country:US
Mailing Address - Phone:806-797-0341
Mailing Address - Fax:
Practice Address - Street 1:2420 QUAKER AVE
Practice Address - Street 2:104
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1817
Practice Address - Country:US
Practice Address - Phone:806-797-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI7125-15122300000X
TX29747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program