Healthcare Provider Details

I. General information

NPI: 1467522391
Provider Name (Legal Business Name): CHRISTOPHER SCOTT RIOLO DDS MS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 WOODLAND SQUARE LOOP SE
LACEY WA
98503-1038
US

IV. Provider business mailing address

1900 PACKARD RD
YPSILANTI MI
48197
US

V. Phone/Fax

Practice location:
  • Phone: 360-359-4860
  • Fax: 360-359-4861
Mailing address:
  • Phone: 734-481-1060
  • Fax: 734-481-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE60069695
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901016305
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: