Provider Demographics
NPI:1760924641
Name:RICKERT, WATSON, & ASSOCIATES, DDS, PLLC
Entity Type:Organization
Organization Name:RICKERT, WATSON, & ASSOCIATES, DDS, PLLC
Other - Org Name:HEALTHY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-760-3084
Mailing Address - Street 1:10009 DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7745
Mailing Address - Country:US
Mailing Address - Phone:919-760-3084
Mailing Address - Fax:
Practice Address - Street 1:9424 FALLS OF NEUSE ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-760-3084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty