Healthcare Provider Details

I. General information

NPI: 1427675396
Provider Name (Legal Business Name): DONNA L RICK DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E BEECH ST
FRUITPORT MI
49415-9210
US

IV. Provider business mailing address

40 E BEECH ST
FRUITPORT MI
49415-9210
US

V. Phone/Fax

Practice location:
  • Phone: 231-865-6141
  • Fax: 231-865-6198
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DONNA L RICK
Title or Position: PRESIDENT
Credential: DDS
Phone: 231-865-6141