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12453 Timberland Blvd Suite 101 Keller TX 76248 | |
| (817) 741-0484 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 12453 Timberland Blvd, Keller, Texas |
| Authorized Official Name and Position | Nicholas Robert Ridder (OWNER) |
| Authorized Official Contact | 8177410484 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12717 Creamello Ave Keller TX 76248-1160 Ph: (817) 741-0484 | 12453 Timberland Blvd Suite 101 Keller TX 76248 Ph: (817) 741-0484 |
| NPI Number | 1841489150 |
|---|---|
| Provider Enumeration Date | 10/23/2007 |
| Last Update Date | 10/26/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841489150 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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