Healthcare Provider Details

I. General information

NPI: 1205747540
Provider Name (Legal Business Name): BRIANNE TRACI RILEY RDH, EPDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 WASHBURN WAY UNIT 240
KLAMATH FALLS OR
97603-4593
US

IV. Provider business mailing address

5933 HILYARD AVE
KLAMATH FALLS OR
97603-7088
US

V. Phone/Fax

Practice location:
  • Phone: 541-331-9577
  • Fax:
Mailing address:
  • Phone: 541-331-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH7149
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: