Healthcare Provider Details

I. General information

NPI: 1528794302
Provider Name (Legal Business Name): RYAN ALEXANDER RICKARDS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 N 7TH ST
PHOENIX AZ
85014-3804
US

IV. Provider business mailing address

80 N MCQUEEN RD APT 3056
GILBERT AZ
85233-5059
US

V. Phone/Fax

Practice location:
  • Phone: 858-999-7290
  • Fax:
Mailing address:
  • Phone: 858-999-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS108908
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012763
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7860
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: