Organization
GREEN MOUNTAIN LLC
Active
Other names
Ricks Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSHUA W RICKS DDS (OWNER/DENTIST)
(716) 472-5745
Entity
Organization
Contact information
Practice address
1625 MINER STREET, IDAHO SPRINGS, CO 80452
(716) 472-5745
Mailing address
PO BOX 277, IDAHO SPRINGS, CO 80452-0277
(716) 472-5745
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
00202483
CO
Other
Enumeration date
04/30/2015
Last updated
04/30/2015
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