Provider Demographics
NPI:1669879755
Name:RICKEY, CIERA JEAN (RDH)
Entity type:Individual
Prefix:
First Name:CIERA
Middle Name:JEAN
Last Name:RICKEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 INDIAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-9503
Mailing Address - Country:US
Mailing Address - Phone:509-936-1943
Mailing Address - Fax:
Practice Address - Street 1:2448 INDIAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-9503
Practice Address - Country:US
Practice Address - Phone:509-936-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist