David Erwin Riddick, DENTIST

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3264 Issued in AR

Practice address

801 W Trimble Ave
Berryville, AR 72616-5101

Phone

(870) 423-3832

Fax

(870) 423-3832

NPI assigned

Aug 15, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1851304133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "BERRYVILLE",
            "state": "AR",
            "postal_code": "726160365",
            "telephone_number": "870-423-3832",
            "fax_number": "870-423-2995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W TRIMBLE AVE",
            "city": "BERRYVILLE",
            "state": "AR",
            "postal_code": "726165101",
            "telephone_number": "870-423-3832",
            "fax_number": "870-423-3832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDICK",
        "first_name": "DAVID",
        "middle_name": "ERWIN",
        "name_prefix": "Dr.",
        "credential": "DENTIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5T911",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA BC/BS",
            "identifier": "974643",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracie Anne Potempa, MHPP
• Vickie Sue Poulson
• Rebecca Zeleny (Family Tree Counseling)
• Bobbie Reed
• Joseph Ricciardi, M.D.
• Anita B. Rissler, CNM
• Robert M. Spurlin D.D.S
• Kayla Roberts, COTA
• Robin Song Doula Care, LLC
• Micheala Roden

• General Practice Dentistry in Berryville, AR
• Providers in Berryville, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.