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General NPI Number Information
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NPI Number | 1912651654
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Entity Type | Organization
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Legal Business Name | RICZARA DENTAL GROUP PC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 8610 MARTIN LUTHER KING BLVD
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City | HOUSTON
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State | TX
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Zip | 77033-2308
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Country | US
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Telephone | 832-400-2194
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Fax | 832-400-2195
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Provider Business Mailing Address
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Address Line | 3711 HIGHWAY 6 S STE 200A
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City | HOUSTON
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State | TX
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Zip | 77082-4326
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Country | US
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Telephone | 281-990-3009
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Fax | 713-777-3368
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | DR. WINIFRED O DIKE
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Credential | DDS
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Telephone | 713-777-3368
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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 |
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License Number State |
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