MEDICARE: ERIC R RIEGER 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	1223G0001X	General Practice Dentistry	DN0012394	FL

General Provider Information

NPI Number	:	1790985067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC R RIEGER DDS

Provider Business Mailing Address
First Line	:	4420 SHERIDAN ST
Second Line	:	APT. B
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3552
Country	:	US
Telephone Number	:	954-966-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 SHERIDAN ST
Second Line	:	APT. B
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3552
Country	:	US
Telephone Number	:	954-966-6352
Fax Number	:

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

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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