Provider Demographics
NPI:1851584601
Name:JAME T RICKMAN IV DDS PC
Entity Type:Organization
Organization Name:JAME T RICKMAN IV DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:RICKMAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-744-9622
Mailing Address - Street 1:4904 MILLRIDGE PARKWAY EAST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:804-744-9622
Mailing Address - Fax:804-744-2806
Practice Address - Street 1:4904 MILLRIDGE PARKWAY EAST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112
Practice Address - Country:US
Practice Address - Phone:804-744-9622
Practice Address - Fax:804-744-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010074941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty