Jacob Riddle, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11900 Issued in TN

Practice address

5366 Estate Office Dr Ste 2
Memphis, TN 38119-0611

Phone

(901) 682-1501

NPI assigned

Jun 9, 2022

Last updated

Aug 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Riddle Dental Arts

  • Dental Clinic/Center
  • Memphis, TN
  • NPI 1477254738
  NPD Authorized official

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1962131227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5366 ESTATE OFFICE DR STE 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190611",
            "telephone_number": "901-682-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5366 ESTATE OFFICE DR STE 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190611",
            "telephone_number": "901-682-1501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "715 Calvin Avery Dr",
            "address_purpose": "LOCATION",
            "city": "West Memphis",
            "state": "AR",
            "postal_code": "723016501",
            "country_code": "US",
            "telephone_number": "870-735-3601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDDLE",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "4634",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1",
            "identifier": "1962131227",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lauren Rickett, NP
• Dana Ricks
• Lauren Taylor Riddick
• Zachary Joseph Riddick
• Riddle Dental Arts
• Jennifer Lynn Riddle
• Mallory Lynn Riddle, DPT
• Ronisha Riddlespriger
• Pamela C Rideout
• Ridge Lake Anesthesia

• General Practice Dentistry in Memphis, TN
• Providers in Memphis, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; 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.