MEDICARE: DR. JOHN JACOB RIEHS 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	1223P0221X	Pediatric Dentistry	20806	TX

General Provider Information

NPI Number	:	1720283567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JACOB RIEHS DDS

Provider Business Mailing Address
First Line	:	4315 HOLLAND AVE APT 15
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2845
Country	:	US
Telephone Number	:	405-819-3918
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 HOLLAND AVE APT 15
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-2845
Country	:	US
Telephone Number	:	405-819-3918
Fax Number	:

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	07/08/2007

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