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General NPI Number Information
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NPI Number | 1043315302
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Entity Type | Organization
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Legal Business Name | RAYNARD RILEY DDS
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 475 SPRINGFIELD AVE SUIT 210
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City | SUMMIT
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State | NJ
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Zip | 07901
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Country | US
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Telephone | 908-273-5656
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Fax | 908-273-5661
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Provider Business Mailing Address
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Address Line | 475 SPRINGFIELD AVE SUIT 210
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City | SUMMIT
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State | NJ
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Zip | 07901
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Country | US
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Telephone | 908-273-5656
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Fax | 908-273-5661
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. RAYNARD OTIS RILEY
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Credential | DDS
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Telephone | 908-273-5656
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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 |
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License Number State |
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