Healthcare Provider Details

I. General information

NPI: 1376626028
Provider Name (Legal Business Name): RICHARD JOHN RIEHM D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 S 48TH ST SUITE 136
PHOENIX AZ
85044-9142
US

IV. Provider business mailing address

15215 S 48TH ST SUITE 136
PHOENIX AZ
85044-9142
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-8550
  • Fax: 480-704-0199
Mailing address:
  • Phone: 480-704-8550
  • Fax: 480-704-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD5108
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: