Provider Demographics
NPI:1205811452
Name:RICKEY, DAVID NATHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NATHAN
Last Name:RICKEY
Suffix:
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 1:1 HAVEN FOR HOPE WAY
Mailing Address - Street 2:BLDG. #1, SUITE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-1108
Mailing Address - Country:US
Mailing Address - Phone:210-220-2322
Mailing Address - Fax:210-220-2311
Practice Address - Street 1:1 HAVEN FOR HOPE WAY
Practice Address - Street 2:BLDG. #1, SUITE 400
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-1108
Practice Address - Country:US
Practice Address - Phone:210-220-2322
Practice Address - Fax:210-220-2311
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist