Provider Demographics
NPI:1487845533
Name:THOMAS E RIDER DDS
Entity Type:Organization
Organization Name:THOMAS E RIDER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-495-8256
Mailing Address - Street 1:PO BOX 6035
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-6035
Mailing Address - Country:US
Mailing Address - Phone:828-495-8256
Mailing Address - Fax:
Practice Address - Street 1:1231 SHILOH CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:828-495-8256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997391Medicaid