Provider Demographics
NPI:1386452134
Name:DENNIS, RICHARD RICKS JR
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:RICKS
Last Name:DENNIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:RICKS
Other - Last Name:DENNIS
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:RICHARD RICKS DENNIS
Mailing Address - Street 1:6353 EVESHAM DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WHCHSTR
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8294
Mailing Address - Country:US
Mailing Address - Phone:614-619-3915
Mailing Address - Fax:
Practice Address - Street 1:6353 EVESHAM DR
Practice Address - Street 2:
Practice Address - City:CANAL WHCHSTR
Practice Address - State:OH
Practice Address - Zip Code:43110-8294
Practice Address - Country:US
Practice Address - Phone:614-619-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker