Healthcare Provider Details

I. General information

NPI: 1457476483
Provider Name (Legal Business Name): DAVID WARE RILEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 VILLAGE HWY
RUSTBURG VA
24588
US

IV. Provider business mailing address

PO BOX 828
RUSTBURG VA
24588-0828
US

V. Phone/Fax

Practice location:
  • Phone: 434-332-5919
  • Fax: 434-332-1740
Mailing address:
  • Phone: 434-332-5919
  • Fax: 434-332-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401005655
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: