Healthcare Provider Details

I. General information

NPI: 1003914276
Provider Name (Legal Business Name): STEVEN SCOTT RILEY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD DENTAL SERVICE (160), V.A. MEDICAL CENTER
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

5805 NW 62ND CT
GAINESVILLE FL
32653-3248
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-379-7450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 8749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: