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General NPI Number Information
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NPI Number | 1003933862
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Entity Type | Individual
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Provider Name | RICKY EUGENE HARRELL DMD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13065 E 17TH PL
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City | AURORA
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State | CO
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Zip | 80045-7238
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Country | US
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Telephone | 303-724-0725
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Fax |
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Provider Business Mailing Address
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Address Line | 13849 LEGEND TRL UNIT 103
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City | BROOMFIELD
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State | CO
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Zip | 80020-8275
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Country | US
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Telephone | 303-469-0735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 104878
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License Number State | CO
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