Provider Demographics
NPI:1811883291
Name:RICKHEIM, DDS, MS, PLLC
Entity type:Organization
Organization Name:RICKHEIM, DDS, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYOR RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-267-8121
Mailing Address - Street 1:1701 W PRAIRIE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8421
Mailing Address - Country:US
Mailing Address - Phone:208-216-0373
Mailing Address - Fax:
Practice Address - Street 1:1701 W PRAIRIE AVE STE 103
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8421
Practice Address - Country:US
Practice Address - Phone:208-216-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICKHEIM, DDS, MS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty