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General NPI Number Information
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NPI Number | 1841489150
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Entity Type | Organization
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Legal Business Name | RIDDER ORTHODONTICS OF FORT WORTH PC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 12453 TIMBERLAND BLVD SUITE 101
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City | KELLER
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State | TX
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Zip | 76248
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Country | US
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Telephone | 817-741-0484
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Fax |
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Provider Business Mailing Address
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Address Line | 12717 CREAMELLO AVE
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City | KELLER
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State | TX
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Zip | 76248-1160
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Country | US
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Telephone | 817-741-0484
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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. NICHOLAS ROBERT RIDDER
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Credential | DDS, MS
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Telephone | 817-741-0484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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