Provider Demographics
NPI:1740859883
Name:RICKS, JAYSON DAVID (DDS)
Entity type:Individual
Prefix:
First Name:JAYSON
Middle Name:DAVID
Last Name:RICKS
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 1:4908 MAGGIE WAY
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1281
Mailing Address - Country:US
Mailing Address - Phone:720-666-1007
Mailing Address - Fax:
Practice Address - Street 1:5270 ELMORE AVE STE 4
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3437
Practice Address - Country:US
Practice Address - Phone:563-209-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-099201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice