Provider Demographics
NPI:1780695866
Name:RICKS, TIMOTHY LOUIS (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LOUIS
Last Name:RICKS
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CORDOBA CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6294
Mailing Address - Country:US
Mailing Address - Phone:775-425-1739
Mailing Address - Fax:
Practice Address - Street 1:PYRAMID LAKE TRIBAL HEALTH CLINIC
Practice Address - Street 2:705 HIGHWAY 446
Practice Address - City:NIXON
Practice Address - State:NV
Practice Address - Zip Code:89424
Practice Address - Country:US
Practice Address - Phone:775-574-1018
Practice Address - Fax:775-574-1028
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2884-951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2884-95OtherDENTAL LICENSE