MEDICARE: DR. DAVID NATHAN RICKEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10543	TX

General Provider Information

NPI Number	:	1205811452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID NATHAN RICKEY DDS

Provider Business Mailing Address
First Line	:	1 HAVEN FOR HOPE WAY
Second Line	:	BLDG. #1, SUITE 400
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-1108
Country	:	US
Telephone Number	:	210-220-2322
Fax Number	:	210-220-2311

Provider Business Practice Location Address
First Line	:	1 HAVEN FOR HOPE WAY
Second Line	:	BLDG. #1, SUITE 400
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-1108
Country	:	US
Telephone Number	:	210-220-2322
Fax Number	:	210-220-2311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	06/09/2013

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