Provider Demographics
NPI:1528088804
Name:RIDGWAY, ALAN B
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:B
Last Name:RIDGWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1448
Mailing Address - Street 2:223 MINNESOTA AVE.
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-1448
Mailing Address - Country:US
Mailing Address - Phone:970-527-3757
Mailing Address - Fax:970-527-4029
Practice Address - Street 1:BOX 1448
Practice Address - Street 2:223 MINNESOTA AVE.
Practice Address - City:PAONIA
Practice Address - State:CO
Practice Address - Zip Code:81428
Practice Address - Country:US
Practice Address - Phone:970-527-3757
Practice Address - Fax:970-527-4029
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COH-D-1047001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice