Provider Demographics
NPI:1700629813
Name:SWINTON, RICKIA JACKEE' LANIECE (RDH)
Entity type:Individual
Prefix:
First Name:RICKIA
Middle Name:JACKEE' LANIECE
Last Name:SWINTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 BOYD DR APT 2
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1093
Mailing Address - Country:US
Mailing Address - Phone:517-499-2882
Mailing Address - Fax:
Practice Address - Street 1:500 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1223
Practice Address - Country:US
Practice Address - Phone:517-748-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902020838124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist