Provider Demographics
NPI:1235213752
Name:RILEY, EDWIN J IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:J
Last Name:RILEY
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:10 HAWTHORNE PLACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-723-4032
Mailing Address - Fax:617-723-4059
Practice Address - Street 1:10 HAWTHORNE PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-723-4032
Practice Address - Fax:617-723-4059
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA199651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice