Provider Demographics
NPI:1851893788
Name:RICKARD, KYLEA GINGER (RDH)
Entity Type:Individual
Prefix:MS
First Name:KYLEA
Middle Name:GINGER
Last Name:RICKARD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 BIMSON AVE
Mailing Address - Street 2:
Mailing Address - City:BERTOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513
Mailing Address - Country:US
Mailing Address - Phone:970-532-4209
Mailing Address - Fax:
Practice Address - Street 1:430 BIMSON AVE
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513
Practice Address - Country:US
Practice Address - Phone:970-532-4209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH002023835124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist