Individual
DR. FRED TAYLOR RIDGE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
115 TURNBERRY WAY, PINEHURST, NC 28374
(910) 695-3100
Mailing address
450 DONALD ROSS DR, PINEHURST, NC 28374-8917
(910) 695-3100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4014
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4014
STATE LICENSE NUMBER
NC
01
—
97393
BLUE CROSS PROVIDER UMBER
NC
Enumeration date
05/15/2007
Last updated
07/08/2007
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