Provider Demographics
NPI:1699889329
Name:RICK, DONNA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNN
Last Name:RICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49415-9300
Mailing Address - Country:US
Mailing Address - Phone:231-865-6141
Mailing Address - Fax:231-865-6198
Practice Address - Street 1:40 BEECH ST
Practice Address - Street 2:
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-9300
Practice Address - Country:US
Practice Address - Phone:231-865-6141
Practice Address - Fax:231-865-6198
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0153521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2587410Medicaid