Healthcare Provider Details

I. General information

NPI: 1801881248
Provider Name (Legal Business Name): BARRY CRAIG RIES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BAYSHORE BLVD
TAMPA FL
33621-1607
US

IV. Provider business mailing address

126 1ST ST E APT 105
TIERRA VERDE FL
33715-1778
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN 16595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: