Provider Demographics
NPI:1477254738
Name:RIDDLE DENTAL ARTS
Entity Type:Organization
Organization Name:RIDDLE DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-487-7622
Mailing Address - Street 1:5366 ESTATE OFFICE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0611
Mailing Address - Country:US
Mailing Address - Phone:901-682-1501
Mailing Address - Fax:901-682-1582
Practice Address - Street 1:5366 ESTATE OFFICE DR STE 2
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0611
Practice Address - Country:US
Practice Address - Phone:901-682-1501
Practice Address - Fax:901-682-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental