MEDICARE: EDWARD L RICK DDS MS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	021-000885	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639322746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD L RICK DDS MS PC

Provider Business Mailing Address
First Line	:	1808 FIRST AVE
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-1202
Country	:	US
Telephone Number	:	815-625-2112
Fax Number	:	815-625-2143

Provider Business Practice Location Address
First Line	:	1808 FIRST AVE
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-1202
Country	:	US
Telephone Number	:	815-625-2112
Fax Number	:	815-625-2143

Authorized Official
Title or Position	:	OFFICER MANAGER
Name	:	MRS. TRACY GAMM
Credential	:
Telephone Number	:	815-625-2112

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/03/2008

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