Provider Demographics
NPI:1205381340
Name:NIDA RIOGA RELATIVO, D.D.S., INC
Entity Type:Organization
Organization Name:NIDA RIOGA RELATIVO, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDA
Authorized Official - Middle Name:RIOGA
Authorized Official - Last Name:RELATIVO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-718-2566
Mailing Address - Street 1:9535 RESEDA BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6028
Mailing Address - Country:US
Mailing Address - Phone:818-718-2566
Mailing Address - Fax:818-718-2479
Practice Address - Street 1:9535 RESEDA BLVD STE 213
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6028
Practice Address - Country:US
Practice Address - Phone:818-718-2566
Practice Address - Fax:818-718-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty