MEDICARE: KIDDER AND KIDDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5901	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82-1801786	OTHER	LA	DENTAL PRACTICE

General Provider Information

NPI Number	:	1154821460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDDER AND KIDDER

Provider Business Mailing Address
First Line	:	6535 PERKINS RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4259
Country	:	US
Telephone Number	:	225-761-8585
Fax Number	:	225-761-1979

Provider Business Practice Location Address
First Line	:	6535 PERKINS RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4259
Country	:	US
Telephone Number	:	225-761-8585
Fax Number	:	225-761-1979

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. DUSTIN KIDDER
Credential	:	DDS
Telephone Number	:	225-761-8585

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	02/14/2018

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Directions to “KIDDER AND KIDDER ” Practice Location

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