Individual
DR. BARRY J ULDRIKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1101 RIATA VALLEY RD., KINGMAN, AZ 86409
(928) 692-9394
(928) 692-9399
Mailing address
1101 RIATA VALLEY RD, KINGMAN, AZ 86409
(928) 692-9394
(928) 692-9399
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AZ3119
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
580937-03
—
AZ
01
—
AZ0471610
BLUECROSS BLUESHIELD
AZ
01
—
D3119
DELTA DENTAL
AZ
Enumeration date
11/30/2006
Last updated
07/09/2007
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