Provider Demographics
NPI:1255370391
Name:RICK, PETER D (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:RICK
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 1:919 S BEECHTREE ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2384
Mailing Address - Country:US
Mailing Address - Phone:616-844-4400
Mailing Address - Fax:616-844-6694
Practice Address - Street 1:919 S BEECHTREE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2384
Practice Address - Country:US
Practice Address - Phone:616-844-4400
Practice Address - Fax:616-844-6694
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist