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NPI Code Detail

MEDICARE: DR. FRED ALBERT RIDDLE DDS

MEDICARE:  DR. FRED ALBERT RIDDLE  DDS
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
11223G0001XGeneral Practice Dentistry5718IA

General Provider Information

NPI Number : 1588786651
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRED ALBERT RIDDLE DDS
Provider Business Mailing Address
First Line : 108 EAST MARKET ST
Second Line :
City : IOWA CITY
State : IA
Zip : 52245-1733
Country : US
Telephone Number : 319-338-1171
Fax Number : 319-337-8350
Provider Business Practice Location Address
First Line : 108 EAST MARKET ST
Second Line :
City : IOWA CITY
State : IA
Zip : 52245-1733
Country : US
Telephone Number : 319-338-1171
Fax Number : 319-337-8350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 03/30/2010

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Directions to “ DR. FRED ALBERT RIDDLE DDS” Practice Location

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