Provider Demographics
NPI:1902213200
Name:ROOT, RICK
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:ROOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 20TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2302
Mailing Address - Country:US
Mailing Address - Phone:772-569-0123
Mailing Address - Fax:772-569-9070
Practice Address - Street 1:3755 20TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2302
Practice Address - Country:US
Practice Address - Phone:772-569-0123
Practice Address - Fax:772-569-9070
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist