Provider Demographics
NPI:1831434281
Name:LD RIGGS PLLC
Entity type:Organization
Organization Name:LD RIGGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:DOUG
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-354-1861
Mailing Address - Street 1:1025 E VANDAMENT AVE
Mailing Address - Street 2:300
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4910
Mailing Address - Country:US
Mailing Address - Phone:405-354-1861
Mailing Address - Fax:
Practice Address - Street 1:1025 E VANDAMENT AVE
Practice Address - Street 2:300
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4910
Practice Address - Country:US
Practice Address - Phone:405-354-1861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200036020BMedicaid