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Individual
DR. JACOB RIDDLE
Active
Individual
DR. JACOB RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4634
AR
1223G0001X
General Practice Dentistry
Primary
11900
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962131227
TYPE 1
—
Enumeration date
06/09/2022
Last updated
08/08/2022
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