Provider Demographics
NPI:1932126927
Name:RICARD FAMILY DENTISTRY, INC.
Entity Type:Organization
Organization Name:RICARD FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:RICARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-398-4680
Mailing Address - Street 1:1818 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5545
Mailing Address - Country:US
Mailing Address - Phone:772-398-4680
Mailing Address - Fax:772-398-4628
Practice Address - Street 1:1818 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5545
Practice Address - Country:US
Practice Address - Phone:772-398-4680
Practice Address - Fax:772-398-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00143651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty