Healthcare Provider Details

I. General information

NPI: 1922105360
Provider Name (Legal Business Name): WALDEMAR RICARDO RIEFKOHL DMD
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

RECEPTION AND MEDICAL CENTER HWY 231
LAKE BUTLER FL
32054-0628
US

IV. Provider business mailing address

4010 NW 67TH PL
GAINESVILLE FL
32653-8353
US

V. Phone/Fax

Practice location:
  • Phone: 386-496-4689
  • Fax:
Mailing address:
  • Phone: 352-374-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 11347
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: