Provider Demographics
NPI:1174722037
Name:LOUIS A. RICCARDI DDSPC
Entity type:Organization
Organization Name:LOUIS A. RICCARDI DDSPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RICCARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:229-924-2224
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-0336
Mailing Address - Country:US
Mailing Address - Phone:229-924-2224
Mailing Address - Fax:229-924-4452
Practice Address - Street 1:1106 FETNER DR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3774
Practice Address - Country:US
Practice Address - Phone:229-294-2224
Practice Address - Fax:229-924-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty