Provider Demographics
NPI:1316415409
Name:RILEY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:RILEY DENTAL ASSOCIATES
Other - Org Name:RILEY DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:434-385-7707
Mailing Address - Street 1:3709 OLD FOREST RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6902
Mailing Address - Country:US
Mailing Address - Phone:434-385-7707
Mailing Address - Fax:
Practice Address - Street 1:3709 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6902
Practice Address - Country:US
Practice Address - Phone:434-385-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental