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General NPI Number Information
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NPI Number | 1073724142
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Entity Type | Individual
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Provider Name | SHANE AUSTIN RICCI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5132 VILLAGE CREEK DR SUITE 400
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City | PLANO
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State | TX
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Zip | 75093-5064
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Country | US
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Telephone | 972-381-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 10604 BLUE BAY DR
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City | FRISCO
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State | TX
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Zip | 75035-8574
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Country | US
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Telephone | 210-912-2985
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0022884
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License Number State | TX
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