Individual
TANIA TRUTER RICCIARDONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
2727 PLEASANT VALLEY RD, MOBILE, AL 36606-2162
(251) 473-5705
Mailing address
25 PADDOCK DR, FAIRHOPE, AL 36532-1117
(225) 678-0568
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
6199
LA
1223G0001X
General Practice Dentistry
Primary
6350
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861995
—
LA
Enumeration date
07/11/2011
Last updated
02/28/2019
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