Individual
DR. GARY LYNN RIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1420 MAIN ST, SCOTT CITY, MO 63780-1936
(573) 264-2020
(573) 264-2678
Mailing address
1420 MAIN ST, SCOTT CITY, MO 63780-1936
(573) 264-2020
(573) 264-2678
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13773
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401916408
—
MO
Enumeration date
12/12/2006
Last updated
01/10/2012
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