Provider Demographics
NPI:1861473092
Name:RIGBY, TED LINDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:LINDON
Last Name:RIGBY
Suffix:
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 1:2190 ACADEMY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1659
Mailing Address - Country:US
Mailing Address - Phone:719-596-3939
Mailing Address - Fax:
Practice Address - Street 1:2190 ACADEMY CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1659
Practice Address - Country:US
Practice Address - Phone:719-596-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-05
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86921223G0001X
UT6501820-99231223G0001X
IDD-41131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67682731Medicaid