Healthcare Provider Details

I. General information

NPI: 1215207386
Provider Name (Legal Business Name): ROBINSON AND RIES ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 CHAPEL HILL RD SUITE B
COLUMBIA MO
65203-6368
US

IV. Provider business mailing address

1609 CHAPEL HILL RD SUITE B
COLUMBIA MO
65203-6368
US

V. Phone/Fax

Practice location:
  • Phone: 573-446-0700
  • Fax: 573-446-2652
Mailing address:
  • Phone: 573-446-0700
  • Fax: 573-446-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13926
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2008015521
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID R RIES
Title or Position: OWNER
Credential: DDS
Phone: 573-446-0700