Provider Demographics
NPI:1669707279
Name:CHARLES S. RICKS
Entity type:Organization
Organization Name:CHARLES S. RICKS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-625-9300
Mailing Address - Street 1:136 S ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5175
Mailing Address - Country:US
Mailing Address - Phone:559-625-9300
Mailing Address - Fax:559-625-9330
Practice Address - Street 1:136 ASPEN COURT
Practice Address - Street 2:SUITE B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-625-9300
Practice Address - Fax:559-624-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23135261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental