Jacob Ryan Rider, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105566 Issued in CA

Practice address

2437 Harbor Blvd
Ventura, CA 93001-3904

Phone

(805) 804-5590

NPI assigned

Jul 5, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jacob Rider DDS Corporation

  • General Practice Dentistry
  • Ventura, CA
  • NPI 1043046378
  NPD Authorized official
• Jacob Rider DDS LLC

  • General Practice Dentistry
  • Ventura, CA
  • NPI 1316779432
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1467717546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2437 HARBOR BLVD",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930013904",
            "telephone_number": "805-804-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2437 HARBOR BLVD",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930013904",
            "telephone_number": "805-804-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDER",
        "first_name": "JACOB",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-05",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Edward Richardson
• Scot J Richardson, M.D.
• Kyra F Riddell, LMFT
• Darlene Rideaux
• Christian Matthew Rider, LMFT
• Rolanda Ridge
• Colleen Ruth Riedell, MFT
• Corine Michelle Riedell, PA-C
• Kelli Elizabeth Riel
• John Riggs, MD

• General Practice Dentistry in Ventura, CA
• Providers in Ventura, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.