Provider Demographics
NPI:1245378090
Name:RIECK, TRISHA LYKE (DDS)
Entity type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:LYKE
Last Name:RIECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TRISHA
Other - Middle Name:MARIE
Other - Last Name:LYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1651 N DALE STREET
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117
Mailing Address - Country:US
Mailing Address - Phone:651-488-5888
Mailing Address - Fax:651-488-8425
Practice Address - Street 1:1651 N DALE STREET
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117
Practice Address - Country:US
Practice Address - Phone:651-488-5888
Practice Address - Fax:651-488-8425
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist