Provider Demographics
NPI:1275224206
Name:RICKETSON, NOLAN SCOTT
Entity type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:SCOTT
Last Name:RICKETSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 GRANTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210-1204
Mailing Address - Country:US
Mailing Address - Phone:205-956-8977
Mailing Address - Fax:
Practice Address - Street 1:3920 GRANTS MILL RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-1204
Practice Address - Country:US
Practice Address - Phone:205-956-8977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007335-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice