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General NPI Number Information
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NPI Number | 1811321060
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Entity Type | Organization
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Legal Business Name | DAVID RIDDICK, DDS, P.C.
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 10912 COLONEL GLENN RD SUITE 3500
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City | LITTLE ROCK
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State | AR
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Zip | 72204-8010
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Country | US
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Telephone | 501-568-6253
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Fax | 501-568-5877
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Provider Business Mailing Address
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Address Line | 10912 COLONEL GLENN RD SUITE 3500
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City | LITTLE ROCK
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State | AR
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Zip | 72204-8010
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Country | US
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Telephone | 501-568-6253
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Fax | 501-568-5877
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID RIDDICK
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Credential | DDS
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Telephone | 501-568-6253
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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 | 3264
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License Number State | AR
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