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NPI Code Detail

MEDICARE: DR. JACOB RYAN RIDER D.D.S.

MEDICARE:  DR. JACOB RYAN RIDER  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry105566CA

General Provider Information

NPI Number : 1467717546
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACOB RYAN RIDER D.D.S.
Provider Business Mailing Address
First Line : 2437 HARBOR BLVD
Second Line :
City : VENTURA
State : CA
Zip : 93001-3904
Country : US
Telephone Number : 805-804-5590
Fax Number :
Provider Business Practice Location Address
First Line : 2437 HARBOR BLVD
Second Line :
City : VENTURA
State : CA
Zip : 93001-3904
Country : US
Telephone Number : 805-804-5590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2012
Last Update Date : 09/12/2024

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Directions to “ DR. JACOB RYAN RIDER D.D.S.” Practice Location

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