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General NPI Number Information
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NPI Number | 1750101705
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Entity Type | Organization
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Legal Business Name | PAUL RIDDLE DDS LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1334 S MAIN ST
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City | OTTAWA
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State | KS
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Zip | 66067-3527
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Country | US
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Telephone | 785-242-5753
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Fax |
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Provider Business Mailing Address
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Address Line | 1334 S MAIN ST
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City | OTTAWA
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State | KS
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Zip | 66067-3527
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Country | US
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Telephone | 785-242-5753
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUFUS PAUL RIDDLE
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Credential | DDS
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Telephone | 479-651-8298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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