1699787432 NPI number — AMY L. RIDALL, DDS PA

Table of content: MRS. SHARON B. DURRENCE R.PH. (NPI 1548255383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699787432 NPI number — AMY L. RIDALL, DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMY L. RIDALL, DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DENTAL SPECIALISTS OF WESTCHASE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699787432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10080 BELLAIRE BOULEVARD
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-575-0742
Provider Business Mailing Address Fax Number:
281-575-0298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10080 BELLAIRE BOULEVARD
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-575-0742
Provider Business Practice Location Address Fax Number:
281-575-0298
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIDALL
Authorized Official First Name:
AMY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT/TREASURER
Authorized Official Telephone Number:
713-271-5942

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  18563 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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