Provider Demographics
NPI:1891132031
Name:MAY, RICKY ALAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:ALAN
Last Name:MAY
Suffix:JR
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 1:235 CAMPBELL LANE
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-5388
Mailing Address - Country:US
Mailing Address - Phone:276-988-5554
Mailing Address - Fax:276-988-5555
Practice Address - Street 1:235 CAMPBELL LANE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-5388
Practice Address - Country:US
Practice Address - Phone:276-988-5554
Practice Address - Fax:276-988-5555
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014140061223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice