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NPI Code Detail

MEDICARE: KATHRYN PARKER RILEY DMD

MEDICARE: KATHRYN PARKER RILEY DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry12857NC

General Provider Information

NPI Number : 1225604903
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN PARKER RILEY DMD
Provider Business Mailing Address
First Line : 6316 E INDEPENDENCE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28212-6953
Country : US
Telephone Number : 980-265-3180
Fax Number :
Provider Business Practice Location Address
First Line : 6316 E INDEPENDENCE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28212-6953
Country : US
Telephone Number : 980-265-3180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2021
Last Update Date : 04/17/2023

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