Provider Demographics
NPI:1801253505
Name:KENNETH RICKS DDS INC
Entity type:Organization
Organization Name:KENNETH RICKS DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-432-7773
Mailing Address - Street 1:5601 AUBURN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-2977
Mailing Address - Country:US
Mailing Address - Phone:661-432-7773
Mailing Address - Fax:
Practice Address - Street 1:5601 AUBURN ST UNIT B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-2977
Practice Address - Country:US
Practice Address - Phone:661-432-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty