Provider Demographics
NPI:1205053899
Name:RICCI, JOHN R (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:RICCI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DARIO DRIVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865
Mailing Address - Country:US
Mailing Address - Phone:401-354-8996
Mailing Address - Fax:
Practice Address - Street 1:1252 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908
Practice Address - Country:US
Practice Address - Phone:401-521-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI8319-7OtherRI BLUE CROSS
RI14316-1OtherDENTAL BENIFITS PROVIDER
RIJR00816OtherRI MEDICAL ASSISTANCE
RIRI 2137OtherDELTA DENTAL OF RI