Provider Demographics
NPI:1720417801
Name:RICKE, MATT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:RICKE
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28741-0070
Mailing Address - Country:US
Mailing Address - Phone:828-526-3513
Mailing Address - Fax:
Practice Address - Street 1:479 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28741-0070
Practice Address - Country:US
Practice Address - Phone:828-526-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist