Provider Demographics
NPI:1407958903
Name:RIEWE, KURT EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:EDWARD
Last Name:RIEWE
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 1:335 E SONTERRA BLVD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-402-6212
Mailing Address - Fax:210-402-6709
Practice Address - Street 1:335 E SONTERRA BLVD.
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-402-6212
Practice Address - Fax:210-402-6709
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742891124OtherTAX ID #