Provider Demographics
NPI:1154483774
Name:RILEY, ANN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:E
Last Name:RILEY
Suffix:
Gender:F
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:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441
Mailing Address - Country:US
Mailing Address - Phone:918-772-3390
Mailing Address - Fax:918-772-3638
Practice Address - Street 1:407 DAISY DR
Practice Address - Street 2:SUITE A
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-431-0202
Practice Address - Fax:918-431-0203
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5760OtherBOARD OF DDS STATE OF OK