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General NPI Number Information
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NPI Number | 1316779432
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Entity Type | Organization
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Legal Business Name | JACOB RIDER DDS LLC
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Dates
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Enumeration Date | 08/16/2024
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 2437 HARBOR BLVD
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City | VENTURA
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State | CA
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Zip | 93001-3904
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Country | US
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Telephone | 805-804-5590
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Fax |
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Provider Business Mailing Address
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Address Line | 702 CEDAR PL
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City | VENTURA
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State | CA
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Zip | 93001-1920
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Country | US
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Telephone | 317-457-0338
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | JACOB RIDER
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Credential |
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Telephone | 317-457-0338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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