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General NPI Number Information
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NPI Number | 1154163624
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Entity Type | Individual
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Provider Name | ANDREW MICHAEL RISLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 1670 LINCOLN HWY E
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City | LANCASTER
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State | PA
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Zip | 17602-2663
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Country | US
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Telephone | 717-394-1067
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Fax |
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Provider Business Mailing Address
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Address Line | 3618 PERRYMAN RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-1046
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Country | US
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Telephone | 228-365-4287
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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 | DS044513
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License Number State | PA
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