Provider Demographics
NPI:1386044311
Name:RILEY, JEFFREY COLTON (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:COLTON
Last Name:RILEY
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 1:7575 CAMBRIDGE ST APT 2401
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2041
Mailing Address - Country:US
Mailing Address - Phone:832-671-3461
Mailing Address - Fax:281-657-2406
Practice Address - Street 1:12626 WOODFOREST BLVD STE Z
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3653
Practice Address - Country:US
Practice Address - Phone:832-673-0999
Practice Address - Fax:281-657-2406
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice