=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831163823
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM A RICKER DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2006
-----------------------------------------------------
Last Update Date | 05/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 149 HART ST 82 MEDICAL GROUP
-----------------------------------------------------
City | SHEPPARD AFB
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76311-3477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-676-4474
-----------------------------------------------------
Fax | 940-676-5903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 SW WILSHIRE BLVD STE 122
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-4741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-676-4474
-----------------------------------------------------
Fax | 940-676-5903
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 14239
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------