Provider Demographics
NPI:1639272958
Name:RICKER, DONALD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:RICKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2550
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2550
Mailing Address - Country:US
Mailing Address - Phone:843-215-0579
Mailing Address - Fax:843-215-0650
Practice Address - Street 1:9356-C HWY 17 BYPASS
Practice Address - Street 2:
Practice Address - City:MURRELS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-215-0579
Practice Address - Fax:843-215-0650
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ32830Medicaid