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NPI Code Detail

MEDICARE: DR. KATHERINA RIESTRA DMD

MEDICARE: DR. KATHERINA RIESTRA 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
1122300000XDentist26026FL

Other Identifiers

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

General Provider Information

NPI Number : 1194394205
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHERINA RIESTRA DMD
Provider Business Mailing Address
First Line : 6230 REESE RD APT 2-203
Second Line :
City : DAVIE
State : FL
Zip : 33314-1219
Country : US
Telephone Number : 305-986-3699
Fax Number :
Provider Business Practice Location Address
First Line : 1711 HAMMONDVILLE RD
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33069-1989
Country : US
Telephone Number : 954-972-6066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2021
Last Update Date : 06/22/2021

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