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General NPI Number Information
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NPI Number | 1669803417
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Entity Type | Organization
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Legal Business Name | RIEL DENTAL PC
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 2323 CLEAR LAKE CITY BLVD SUITE 140
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City | HOUSTON
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State | TX
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Zip | 77062-8120
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Country | US
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Telephone | 281-488-3626
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Fax |
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Provider Business Mailing Address
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Address Line | 2323 CLEAR LAKE CITY BLVD SUITE 140
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City | HOUSTON
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State | TX
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Zip | 77062-8120
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Country | US
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Telephone | 281-488-3626
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JUSTIN D RIEL
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Credential | DMD
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Telephone | 832-545-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 28670
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License Number State | TX
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