Provider Demographics
NPI:1437767209
Name:RIEGEL, AUDREY (DMD, MS)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:RIEGEL
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W HORIZON RIDGE PKWY APT 2721
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4437
Mailing Address - Country:US
Mailing Address - Phone:970-769-2771
Mailing Address - Fax:
Practice Address - Street 1:2610 W HORIZON RIDGE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2870
Practice Address - Country:US
Practice Address - Phone:702-270-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204430122300000X
NVS4-1341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist