Provider Demographics
NPI:1649286196
Name:RICKENBACH, NANNETTE LORRAINE (DMD)
Entity type:Individual
Prefix:DR
First Name:NANNETTE
Middle Name:LORRAINE
Last Name:RICKENBACH
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:HUMACOA MEDICAL PLAZA
Mailing Address - Street 2:53 CALLE FONT MARTELO E SUITE 201
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3634
Mailing Address - Country:US
Mailing Address - Phone:787-852-6976
Mailing Address - Fax:787-852-6976
Practice Address - Street 1:HUMACAO MEDICAL PLAZA SUITE 201
Practice Address - Street 2:CALLA FONT MARTELO #53
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3634
Practice Address - Country:US
Practice Address - Phone:787-852-6976
Practice Address - Fax:787-852-6976
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-11-20
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Provider Licenses
StateLicense IDTaxonomies
PR24551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice