Individual
DR. JACOB RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5366 ESTATE OFFICE DR STE 2, MEMPHIS, TN 38119-0611
(901) 682-1501
Mailing address
5366 ESTATE OFFICE DR STE 2, MEMPHIS, TN 38119-0611
(901) 682-1501
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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