Provider Demographics
NPI:1912303652
Name:RICCA, CHRISTEN ELISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTEN
Middle Name:ELISE
Last Name:RICCA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 EASTON RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2852
Mailing Address - Country:US
Mailing Address - Phone:215-491-2139
Mailing Address - Fax:215-491-8649
Practice Address - Street 1:1432 EASTON RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2852
Practice Address - Country:US
Practice Address - Phone:215-491-2139
Practice Address - Fax:215-491-8649
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist