Provider Demographics
NPI:1679028682
Name:ROCHELLE J RILEY DDSMS PLLC
Entity type:Organization
Organization Name:ROCHELLE J RILEY DDSMS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY WICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-845-9507
Mailing Address - Street 1:2903 E MAIN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3169
Mailing Address - Country:US
Mailing Address - Phone:253-845-9507
Mailing Address - Fax:
Practice Address - Street 1:2903 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3169
Practice Address - Country:US
Practice Address - Phone:253-845-9507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty