MEDICARE: ERIC D. RICKS , DDS, PLLC

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	122300000X	Dentist	25649	TX

General Provider Information

NPI Number	:	1730578956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC D. RICKS , DDS, PLLC

Provider Business Mailing Address
First Line	:	7430 N BEACH ST
Second Line	:	SUITE 312
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1541
Country	:	US
Telephone Number	:	817-428-6100
Fax Number	:	817-428-6103

Provider Business Practice Location Address
First Line	:	7430 N BEACH ST
Second Line	:	SUITE 312
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1541
Country	:	US
Telephone Number	:	817-428-6100
Fax Number	:	817-428-6103

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERIC DEAN RICKS
Credential	:	D.D.S
Telephone Number	:	817-428-6100

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/12/2015

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