Healthcare Provider Details

I. General information

NPI: 1982203584
Provider Name (Legal Business Name): CRYSTEL ANANOS RIGGS DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE OCEAN BLVD STE 248
STUART FL
34994-3501
US

IV. Provider business mailing address

900 SE OCEAN BLVD STE 248
STUART FL
34994-3501
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-4171
  • Fax:
Mailing address:
  • Phone: 772-220-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTEL ANANOS RIGGS
Title or Position: PRES
Credential: DMD
Phone: 772-220-4171