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General NPI Number Information
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NPI Number | 1881667053
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Entity Type | Individual
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Provider Name | RISA MAREE RECORD D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 618 DENTAL COMPANY (AS) UNIT #15662 BLDG. S137 TEXAS AVENUE
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City | CAMP CARROLL
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State | APO AP
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Zip | 96260-5662
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Country | KR
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Telephone | 352-765-7185
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Fax | 352-765-7188
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Provider Business Mailing Address
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Address Line | 162 COUNTY ROAD 294
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City | GAINESVILLE
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State | TX
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Zip | 76240-8436
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Country | US
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Telephone | 940-612-2916
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | BR9294353
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License Number State | TX
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