Provider Demographics
NPI:1871645804
Name:RICKER, FREDERICK K (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:K
Last Name:RICKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:K
Other - Last Name:RICKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1719 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4215
Mailing Address - Country:US
Mailing Address - Phone:423-639-3861
Mailing Address - Fax:423-639-3803
Practice Address - Street 1:1719 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4215
Practice Address - Country:US
Practice Address - Phone:423-639-3861
Practice Address - Fax:423-639-3803
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist