Healthcare Provider Details

I. General information

NPI: 1821076936
Provider Name (Legal Business Name): RONALD MILTON RIESNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E GRANT AVE
WINTERS CA
95694-1761
US

IV. Provider business mailing address

111 E GRANT AVE
WINTERS CA
95694-1761
US

V. Phone/Fax

Practice location:
  • Phone: 530-795-4556
  • Fax: 530-795-4557
Mailing address:
  • Phone: 530-795-4556
  • Fax: 530-795-4557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: