# RIDDER DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kokomo Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760113534
- **Authorized official:** JACLYN KRISTINE RIDDER DDS (OWNER)
- **Authorized official phone:** (317) 418-1342

## Contact information

- **Practice address:** 604 E BOULEVARD STE A, KOKOMO, IN 46902-2286
- **Practice address phone:** (765) 864-2325
- **Mailing address:** 6706 JUNE ROSE CT, NOBLESVILLE, IN 46062-9512
- **Mailing address phone:** (317) 418-1342

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 06/22/2022
- **Last updated:** 06/22/2022