MEDICARE: MATTHEW LEE RIGGS D.D.S.

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	58514	CA

General Provider Information

NPI Number	:	1851524904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW LEE RIGGS D.D.S.

Provider Business Mailing Address
First Line	:	22981 SONRIENTE TRL
Second Line	:
City	:	COTO DE CAZA
State	:	CA
Zip	:	92679-3601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2382 SE BRISTOL ST
Second Line	:	SUITE A
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-0756
Country	:	US
Telephone Number	:	949-752-1210
Fax Number	:	949-752-1220

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

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	08/24/2009

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