Provider Demographics
NPI:1952404162
Name:PRENTICE, RICARDA NOELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICARDA
Middle Name:NOELLE
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 W 144TH AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6123
Mailing Address - Country:US
Mailing Address - Phone:303-468-7722
Mailing Address - Fax:
Practice Address - Street 1:3800 W 144TH AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-6123
Practice Address - Country:US
Practice Address - Phone:303-468-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics