Provider Demographics
NPI:1639104995
Name:RICKEY, ROBERT KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENT
Last Name:RICKEY
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 1:104 PIEDMONT ROAD
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078
Mailing Address - Country:US
Mailing Address - Phone:405-373-4566
Mailing Address - Fax:405-378-1307
Practice Address - Street 1:104 PIEDMONT ROAD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078
Practice Address - Country:US
Practice Address - Phone:405-373-4566
Practice Address - Fax:405-378-1307
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist