Provider Demographics
NPI:1477572642
Name:RIDER, HAROLD CONRAD III (DDS)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:CONRAD
Last Name:RIDER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BURKE ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3784
Mailing Address - Country:US
Mailing Address - Phone:337-365-1512
Mailing Address - Fax:
Practice Address - Street 1:129 BURKE ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3784
Practice Address - Country:US
Practice Address - Phone:337-365-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice