Healthcare Provider Details

I. General information

NPI: 1003279290
Provider Name (Legal Business Name): RILEY CASELLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RILEY BALDWIN

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 TOWNE AVE
PLAINFIELD VT
05667-9425
US

IV. Provider business mailing address

157 TOWNE AVE
PLAINFIELD VT
05667-9425
US

V. Phone/Fax

Practice location:
  • Phone: 802-454-8336
  • Fax: 802-454-8339
Mailing address:
  • Phone: 802-454-8336
  • Fax: 802-454-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016.0129953
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0129953
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: