Provider Demographics
NPI:1598812117
Name:FELTON, RICKEY EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:EDWIN
Last Name:FELTON
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 1:1008 CENTRE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2089
Mailing Address - Country:US
Mailing Address - Phone:970-221-4633
Mailing Address - Fax:970-221-4660
Practice Address - Street 1:1008 CENTRE AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2089
Practice Address - Country:US
Practice Address - Phone:970-221-4633
Practice Address - Fax:970-221-4660
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery