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General NPI Number Information
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NPI Number | 1760113534
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Entity Type | Organization
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Legal Business Name | RIDDER DENTAL LLC
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 604 E BOULEVARD STE A
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City | KOKOMO
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State | IN
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Zip | 46902-2286
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Country | US
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Telephone | 765-864-2325
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Fax |
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Provider Business Mailing Address
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Address Line | 6706 JUNE ROSE CT
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City | NOBLESVILLE
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State | IN
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Zip | 46062-9512
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Country | US
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Telephone | 317-418-1342
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACLYN KRISTINE RIDDER
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Credential | DDS
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Telephone | 317-418-1342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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