Healthcare Provider Details

I. General information

NPI: 1831876366
Provider Name (Legal Business Name): RILEY SANOCKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 CASSIDY RD
FORT BLISS TX
79916-3502
US

IV. Provider business mailing address

2901 CASSIDY RD
FORT BLISS TX
79916-3502
US

V. Phone/Fax

Practice location:
  • Phone: 651-280-5540
  • Fax:
Mailing address:
  • Phone: 651-280-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD14894
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD14894
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: