MEDICARE: MARILYN PATRICIA RILEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN17611	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114941614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN PATRICIA RILEY DMD

Provider Business Mailing Address
First Line	:	3909 N ANDREWS AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-5239
Country	:	US
Telephone Number	:	954-561-6675
Fax Number	:	954-630-2017

Provider Business Practice Location Address
First Line	:	3909 N ANDREWS AVE
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-5239
Country	:	US
Telephone Number	:	954-561-6675
Fax Number	:	954-630-2017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	01/30/2015

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