Active NPI
Andrew Lawrence Riddle, DMD
- Dentist
- Portland, OR
National Provider Identifier
1386472207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D12054
- Practice address
- 2267 NW Pettygrove St
Portland, OR 97210-2760 - Phone
- (503) 224-6317
- NPI assigned
- Jul 23, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D12054 | OR | Primary |
Addresses
Primary practice location
2267 NW Pettygrove St
Portland, OR 97210-2760
Mailing address
2120 SW Dolph CT
Portland, OR 97219-4175
Phone (801) 707-4012
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12054 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787529600000",
"number": "1386472207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2120 SW DOLPH CT",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972194175",
"telephone_number": "801-707-4012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2267 NW PETTYGROVE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972102760",
"telephone_number": "503-224-6317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDDLE",
"first_name": "ANDREW",
"middle_name": "LAWRENCE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-23",
"last_updated": "2026-08-24",
"certification_date": "2026-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D12054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.