Provider Demographics
NPI:1750313714
Name:RICKARDS, MARK E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:RICKARDS
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 1:5530 NEW FALLS RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-3102
Mailing Address - Country:US
Mailing Address - Phone:215-945-5100
Mailing Address - Fax:775-640-3064
Practice Address - Street 1:5530 NEW FALLS RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-3102
Practice Address - Country:US
Practice Address - Phone:215-945-5100
Practice Address - Fax:775-640-3064
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice