Provider Demographics
NPI:1356402945
Name:RICAUD, ARTIE (DDS CDT)
Entity type:Individual
Prefix:DR
First Name:ARTIE
Middle Name:
Last Name:RICAUD
Suffix:
Gender:M
Credentials:DDS CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N JEFF DAVIS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1669
Mailing Address - Country:US
Mailing Address - Phone:770-461-3921
Mailing Address - Fax:770-461-0944
Practice Address - Street 1:320 N JEFF DAVIS DR
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1669
Practice Address - Country:US
Practice Address - Phone:770-461-3921
Practice Address - Fax:770-461-0944
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist