MEDICARE: LYNDA ROBERTS-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
1	122300000X	Dentist	30-017078	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598732653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA ROBERTS-RIDDLE DDS

Provider Business Mailing Address
First Line	:	7697 GREENFARMS DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1213
Country	:	US
Telephone Number	:	513-521-4902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 STEFFEN AVE
Second Line	:
City	:	LINCOLN HEIGHTS
State	:	OH
Zip	:	45215-2338
Country	:	US
Telephone Number	:	513-483-3087
Fax Number	:	513-554-0136

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	03/07/2023

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