Provider Demographics
NPI:1730233107
Name:RICKMAN, JAMES T IV (DDS, PC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:T
Last Name:RICKMAN
Suffix:IV
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 MILLRIDGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4828
Mailing Address - Country:US
Mailing Address - Phone:804-744-9622
Mailing Address - Fax:
Practice Address - Street 1:4904 MILLRIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4828
Practice Address - Country:US
Practice Address - Phone:804-744-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010074941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice