Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 0361 | SC |
NPI | 1184975484 |
---|---|
Provider Name | Dr. Donald L Ridgell |
First Address | Greenville, SC 29605-4021 |
Second Address | Greenville, SC 29605-4021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2012 |
Last Update Date | 26/09/2012 |