Provider Demographics
NPI:1437843620
Name:WALIA, RIYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:RIYA
Middle Name:
Last Name:WALIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SE 5TH AVE APT 607
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2994
Mailing Address - Country:US
Mailing Address - Phone:586-344-0171
Mailing Address - Fax:
Practice Address - Street 1:510 SE 5TH AVE APT 607
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2994
Practice Address - Country:US
Practice Address - Phone:586-344-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN279171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry