Provider Demographics
NPI:1518081504
Name:ROBERT F RICKETTS, DDS, PA
Entity Type:Organization
Organization Name:ROBERT F RICKETTS, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-667-4143
Mailing Address - Street 1:122 WILKESBORO AVE
Mailing Address - Street 2:P.O. BOX 157
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4218
Mailing Address - Country:US
Mailing Address - Phone:336-667-4143
Mailing Address - Fax:
Practice Address - Street 1:122 WILKESBORO AVE
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4218
Practice Address - Country:US
Practice Address - Phone:336-667-4143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty