Provider Demographics
NPI:1093876146
Name:RIEDEL, CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:RIEDEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16453 HIGHWAY 62 S
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-1986
Mailing Address - Country:US
Mailing Address - Phone:409-882-9304
Mailing Address - Fax:409-670-1039
Practice Address - Street 1:16453 HIGHWAY 62 S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-1986
Practice Address - Country:US
Practice Address - Phone:409-882-9304
Practice Address - Fax:409-670-1039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice