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General NPI Number Information
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NPI Number | 1932770609
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Entity Type | Organization
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Legal Business Name | RIDDLE MODERN DENTISTRY & IMPLANTS
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Dates
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Enumeration Date | 07/05/2021
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Last Update Date | 07/05/2021
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Provider Practice Location Address
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Address Line | 2600 MARKET TRCE
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City | FORT SMITH
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State | AR
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Zip | 72908-8681
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Country | US
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Telephone | 479-651-8298
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Fax |
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Provider Business Mailing Address
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Address Line | 10412 STONELEIGE ST
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City | FORT SMITH
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State | AR
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Zip | 72908-0740
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Country | US
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Telephone | 479-651-8298
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PAUL RIDDLE
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Credential | DDS
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Telephone | 479-651-8298
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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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