Active NPI
Rickin Vibhakar
- General Practice Dentistry
- Decatur, GA
National Provider Identifier
1609257765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 058685-1
- Practice address
- 315 W Ponce de Leon Ave Ste 240
Decatur, GA 30030-2483 - Phone
- (630) 740-2042
- NPI assigned
- Jun 15, 2015
- Last updated
- Aug 2, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 058685-1 | NY | Primary |
Addresses
Primary practice location
315 W Ponce de Leon Ave Ste 240
Decatur, GA 30030-2483
Mailing address
1631 Stanwood Ave SE
Atlanta, GA 30317-1911
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 058685-1 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754092800000",
"number": "1609257765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1631 STANWOOD AVE SE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303171911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 W PONCE DE LEON AVE STE 240",
"city": "DECATUR",
"state": "GA",
"postal_code": "300302483",
"telephone_number": "630-740-2042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIBHAKAR",
"first_name": "RICKIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-15",
"last_updated": "2025-08-02",
"certification_date": "2025-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "058685-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.