Provider Demographics
NPI:1366700692
Name:RICKS, STEPHEN LEON (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEON
Last Name:RICKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-1300
Mailing Address - Country:US
Mailing Address - Phone:701-852-2455
Mailing Address - Fax:701-852-2938
Practice Address - Street 1:900 20TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-1300
Practice Address - Country:US
Practice Address - Phone:701-852-2455
Practice Address - Fax:701-852-2938
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND90-15331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40102Medicaid