Provider Demographics
NPI:1831163823
Name:RICKER, WILLIAM A (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:RICKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:RICKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:251 SW WILSHIRE BLVD
Mailing Address - Street 2:STE 122
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4741
Mailing Address - Country:US
Mailing Address - Phone:940-676-4474
Mailing Address - Fax:940-676-5903
Practice Address - Street 1:149 HART ST
Practice Address - Street 2:82 MEDICAL GROUP
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-3477
Practice Address - Country:US
Practice Address - Phone:940-676-4474
Practice Address - Fax:940-676-5903
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVAD 000Medicare UPIN