=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447894084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR ROBERT C RIEGEL DDS APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2019
-----------------------------------------------------
Last Update Date | 11/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1016 E COOLEY DR STE F
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-553-5226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1016 E COOLEY DR STE F
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-553-5226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. JUDY G REPPOND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-553-5226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------