MEDICARE: DR. IRVING NORFLIN RILEY 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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	015422	MI
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	59129	CA

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	:	1215922760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRVING NORFLIN RILEY DDS

Provider Business Mailing Address
First Line	:	301 ALAMO DR
Second Line	:	SUITE E
City	:	VACAVILLE
State	:	CA
Zip	:	95688-4246
Country	:	US
Telephone Number	:	707-447-0989
Fax Number	:	707-447-6829

Provider Business Practice Location Address
First Line	:	301 ALAMO DR
Second Line	:	SUITE E
City	:	VACAVILLE
State	:	CA
Zip	:	95688-4246
Country	:	US
Telephone Number	:	707-447-0989
Fax Number	:	707-447-6829

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	01/13/2012

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