Provider Demographics
NPI:1447435359
Name:RICKETTS, BENJAMIN PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PAUL
Last Name:RICKETTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 S MAIN ST
Mailing Address - Street 2:285
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5376
Mailing Address - Country:US
Mailing Address - Phone:303-627-5420
Mailing Address - Fax:303-627-5423
Practice Address - Street 1:6240 S MAIN ST
Practice Address - Street 2:285
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5376
Practice Address - Country:US
Practice Address - Phone:303-627-5420
Practice Address - Fax:303-627-5423
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010975A390200000X, 1223E0200X
CODEN.000102731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program