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General NPI Number Information
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NPI Number | 1912102070
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Entity Type | Individual
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Provider Name | ELIZABETH M KIDDER D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6535 PERKINS ROAD
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City | BATON ROUGE
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State | LA
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Zip | 70808
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Country | US
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Telephone | 225-761-8585
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Fax | 225-761-1979
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Provider Business Mailing Address
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Address Line | 6535 PERKINS ROAD
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City | BATON ROUGE
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State | LA
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Zip | 70808
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Country | US
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Telephone | 225-761-8585
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Fax | 225-761-1979
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12736
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6020015
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6640
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License Number State | LA
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