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NPI Code Detail

MEDICARE: DR. KENNETH PAUL RIELAND DDS

MEDICARE: DR. KENNETH PAUL RIELAND DDS
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
1122300000XDentist25444CA

General Provider Information

NPI Number : 1124293964
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH PAUL RIELAND DDS
Provider Business Mailing Address
First Line : 744 BROADWAY ST
Second Line :
City : EL CAJON
State : CA
Zip : 92021
Country : US
Telephone Number : 619-440-0071
Fax Number :
Provider Business Practice Location Address
First Line : 744 BROADWAY
Second Line :
City : EL CAJON
State : CA
Zip : 92021-4654
Country : US
Telephone Number : 619-440-0071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2008
Last Update Date : 04/23/2008

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Directions to “ DR. KENNETH PAUL RIELAND DDS” Practice Location

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