# RICKE DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Boone Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023731551
- **Authorized official:** DR. MATT J RICKE DDS (MANAGER)
- **Authorized official phone:** (919) 781-8610

## Contact information

- **Practice address:** 2310 MYRON DR, RALEIGH, NC 27607-0059
- **Practice address phone:** (919) 781-8610
- **Mailing address:** 512 FALLON GROVE WAY, RALEIGH, NC 27608-1879
- **Mailing address phone:** (904) 307-1239

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2022
- **Last updated:** 09/20/2022