Provider Demographics
NPI:1437685245
Name:RILEY FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:RILEY FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GILMORE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-325-0035
Mailing Address - Street 1:7561 WALL TRIANA HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-8327
Mailing Address - Country:US
Mailing Address - Phone:256-325-0035
Mailing Address - Fax:
Practice Address - Street 1:7561 WALL TRIANA HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-8327
Practice Address - Country:US
Practice Address - Phone:256-325-0035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5699261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental