Provider Demographics
NPI:1881261923
Name:RICKER, MARIAH SUMMER (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:SUMMER
Last Name:RICKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8314
Mailing Address - Country:US
Mailing Address - Phone:423-736-8212
Mailing Address - Fax:
Practice Address - Street 1:1025 W 1ST NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4551
Practice Address - Country:US
Practice Address - Phone:423-581-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist