Healthcare Provider Details

I. General information

NPI: 1629515820
Provider Name (Legal Business Name): CHRISTOPHER MARK RICKER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PARK DENTAL DEPARTMENT
COLUMBIA SC
29203
US

IV. Provider business mailing address

9920 KINCEY AVE STE 280
HUNTERSVILLE NC
28078-2400
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6567
  • Fax: 803-434-6299
Mailing address:
  • Phone: 704-322-3000
  • Fax: 704-755-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10739
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: