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General NPI Number Information
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NPI Number | 1033092226
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Entity Type | Individual
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Provider Name | RILEY THOMAS CRISMON DDS
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Gender | Male
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 1201 N STONEWALL AVE RM 253
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City | OKLAHOMA CITY
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State | OK
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Zip | 73117-1214
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Country | US
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Telephone | 405-271-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 WESTCHESTER DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-1428
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Country | US
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Telephone | 918-706-3965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8024
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License Number State | OK
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