Individual
MS. SHELLY LYNNE RICKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2620 NEW BERN AVE, NEW BERN RIDGE DENTAL CENTER, RALEIGH, NC 27610-1821
(919) 250-2930
(919) 231-8077
Mailing address
118 BRUCE DRIVE, CARY, NC 27511
(919) 467-8759
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6459
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
899001C
—
NC
01
—
9001C
BLUE CROSS BLUE SHIELD
NC
Enumeration date
10/23/2006
Last updated
07/08/2007
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