Provider Demographics
NPI:1508906637
Name:RICKS, BRUCE MARC (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MARC
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 1:918 N 7TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3195
Mailing Address - Country:US
Mailing Address - Phone:970-245-1988
Mailing Address - Fax:
Practice Address - Street 1:918 N 7TH ST STE 1
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3195
Practice Address - Country:US
Practice Address - Phone:970-245-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist