Provider Demographics
NPI:1447610365
Name:MARK S. RIEDERER D.D.S. LLC.
Entity Type:Organization
Organization Name:MARK S. RIEDERER D.D.S. LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEDERER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-789-3100
Mailing Address - Street 1:9309 GLACIER HWY STE A101
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7018
Mailing Address - Country:US
Mailing Address - Phone:907-789-3100
Mailing Address - Fax:
Practice Address - Street 1:9309 GLACIER HWY STE A101
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7018
Practice Address - Country:US
Practice Address - Phone:907-789-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA6511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty