Provider Demographics
NPI:1295392298
Name:RIETOW, JOSEPH FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRANK
Last Name:RIETOW
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 1:3175 ROSEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-9571
Mailing Address - Country:US
Mailing Address - Phone:574-806-2956
Mailing Address - Fax:
Practice Address - Street 1:1800 S US HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8681
Practice Address - Country:US
Practice Address - Phone:574-772-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013158A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice