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DR. GARY LYNN RIDDLE DDS

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1942361365

Individual Registrant:
DR. GARY LYNN RIDDLE DDS
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

Contact information for business:
1420 MAIN ST  SCOTT CITY, MO 63780-1936 US
Tel: 573-264-2020  Fax: 573-264-2678

Registration Information:
NPI: 1942361365
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
MO13773

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
401916408MO05




HEALTH CARE JOBS MO - Page 1



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