=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598732653
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNDA ROBERTS-RIDDLE DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 STEFFEN AVE
-----------------------------------------------------
City | LINCOLN HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45215-2338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-483-3087
-----------------------------------------------------
Fax | 513-554-0136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7697 GREENFARMS DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45224-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-521-4902
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30-017078
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------