Provider Demographics
NPI:1497912950
Name:TERRY R RIECK DDS PC
Entity Type:Organization
Organization Name:TERRY R RIECK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:RIECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-255-1195
Mailing Address - Street 1:4019 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2710
Mailing Address - Country:US
Mailing Address - Phone:515-255-1195
Mailing Address - Fax:515-255-1195
Practice Address - Street 1:4019 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2710
Practice Address - Country:US
Practice Address - Phone:515-255-1195
Practice Address - Fax:515-255-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty