Healthcare Provider Details

I. General information

NPI: 1417481748
Provider Name (Legal Business Name): RAQUEL RIOS D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 EAST MARKET ST. SUMMA HEALTH GENERAL PRACTICE DENTAL RESIDENCY
AKRON OH
44304-1619
US

IV. Provider business mailing address

525 EAST MARKET ST. SUMMA HEALTH GENERAL PRACTICE DENTAL RESIDENCY
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-6262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025366
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: