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DR. GARY LYNN RIDDLE DDS
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1942361365
Individual Registrant:DR. GARY LYNN RIDDLE DDS
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
1420 MAIN ST SCOTT CITY, MO 63780-1936 US
Tel: 573-264-2020 Fax: 573-264-2678
Tel: 573-264-2020 Fax: 573-264-2678
Contact information for business:
1420 MAIN ST SCOTT CITY, MO 63780-1936 US
Tel: 573-264-2020 Fax: 573-264-2678
Tel: 573-264-2020 Fax: 573-264-2678
Registration Information:
NPI: 1942361365
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | MO | 13773 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 401916408 | MO | 05 |
