Organization
RIDDLE DENTAL CARE ASSOCIATES
Active
Other names
Jeffrey D Baxter
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLORIA J MANN (ACCOUNTS MANAGER SEC TREAS)
(541) 874-3126
Entity
Organization
Contact information
Practice address
150 S MAIN ST, RIDDLE, OR 97469
(541) 874-3126
(541) 874-3259
Mailing address
PO BOX 107, 150 S MAIN, RIDDLE, OR 97469
(541) 863-5524
(541) 874-3259
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6774
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
074612
—
OR
01
—
6774
DENTAL
OR
Enumeration date
08/31/2006
Last updated
02/25/2008
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