Provider Demographics
NPI:1407179229
Name:RIDD, JOHN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:RIDD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-1111
Mailing Address - Country:US
Mailing Address - Phone:570-226-1919
Mailing Address - Fax:570-226-7499
Practice Address - Street 1:219 HUDSON ST
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-1111
Practice Address - Country:US
Practice Address - Phone:570-226-1919
Practice Address - Fax:570-226-7499
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026916L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist