Provider Demographics
NPI:1043294887
Name:RIGGS, DOUG (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUG
Middle Name:
Last Name:RIGGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-3911
Mailing Address - Country:US
Mailing Address - Phone:405-256-0500
Mailing Address - Fax:405-256-0414
Practice Address - Street 1:210 N MUSTANG RD
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-3911
Practice Address - Country:US
Practice Address - Phone:405-256-0500
Practice Address - Fax:405-256-0414
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200036020AMedicaid