=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558128066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN ARRIETA RICAURTE DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2024
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2745 PEMBROOK PL
-----------------------------------------------------
City | MANHATTAN
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66502-7482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-539-4601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 S MIRAMAR AVE APT 2205
-----------------------------------------------------
City | INDIALANTIC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32903-3286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-952-8850
-----------------------------------------------------
Fax | 941-952-8850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30.027536
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 62277
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------