Provider Demographics
NPI:1912651654
Name:RICZARA DENTAL GROUP PC
Entity Type:Organization
Organization Name:RICZARA DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:O
Authorized Official - Last Name:DIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-777-3368
Mailing Address - Street 1:3711 HIGHWAY 6 S STE 200A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-4326
Mailing Address - Country:US
Mailing Address - Phone:281-990-3009
Mailing Address - Fax:713-777-3368
Practice Address - Street 1:8610 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-2308
Practice Address - Country:US
Practice Address - Phone:832-400-2194
Practice Address - Fax:832-400-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty