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General NPI Number Information
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NPI Number | 1811285182
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Entity Type | Individual
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Provider Name | PAIGE COVINGTON RIDDLE D.D.S., M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 309 SW MARKET ST
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2315
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Country | US
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Telephone | 816-246-4671
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 N PIEDRAS ST
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City | EL PASO
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State | TX
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Zip | 79920-5001
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Country | US
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Telephone | 915-744-6083
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3816
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2015012809
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License Number State | MO
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