Provider Demographics
NPI:1023131315
Name:WEARDA, RICK WILLIAM
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:WILLIAM
Last Name:WEARDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LAS TABLAS RD STE 8
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9792
Mailing Address - Country:US
Mailing Address - Phone:805-434-2811
Mailing Address - Fax:805-434-2243
Practice Address - Street 1:1050 LAS TABLAS RD STE 8
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9792
Practice Address - Country:US
Practice Address - Phone:805-434-2811
Practice Address - Fax:805-434-2243
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist