Provider Demographics
NPI:1730221177
Name:RICKARDS, ROBERT BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:RICKARDS
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 1:117 W DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048
Mailing Address - Country:US
Mailing Address - Phone:918-273-1619
Mailing Address - Fax:918-273-1619
Practice Address - Street 1:117 W DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048
Practice Address - Country:US
Practice Address - Phone:918-273-1619
Practice Address - Fax:918-273-1619
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist