Shelly Lynne Rickert, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

6459 Issued in NC

Practice address

2620 New Bern Ave
New Bern Ridge Dental Center
Raleigh, NC 27610-1821

Phone

(919) 250-2930

Fax

(919) 231-8077

NPI assigned

Oct 23, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578646675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 BRUCE DRIVE",
            "city": "CARY",
            "state": "NC",
            "postal_code": "27511",
            "telephone_number": "919-467-8759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 NEW BERN AVE",
            "address_2": "NEW BERN RIDGE DENTAL CENTER",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101821",
            "telephone_number": "919-250-2930",
            "fax_number": "919-231-8077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKERT",
        "first_name": "SHELLY",
        "middle_name": "LYNNE",
        "name_prefix": "Ms.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "6459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "899001C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "9001C",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eternia Sade Richmond
• Tanay Richmond
• Ellen Louise Richter, CCC-SPEECH
• Ricke DDS PLLC (Lake Boone Dentistry)
• Patricia S Rickenbaker, LISW
• Rickert, Watson, & Associates, DDS, PLLC (Healthy Smiles)
• Shauna Mackenzie Rickerts, RN, BSN
• Renee Y. Ricks, MOTR/L
• Anthony L Rico, M.D.
• Jete' Riddick

• Dentist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.