Provider Demographics
NPI:1518190800
Name:RILEY, MICHAEL BRENT JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRENT
Last Name:RILEY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 OLD FOREST RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6902
Mailing Address - Country:US
Mailing Address - Phone:434-665-1430
Mailing Address - Fax:434-385-0738
Practice Address - Street 1:3709 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6902
Practice Address - Country:US
Practice Address - Phone:434-385-7707
Practice Address - Fax:434-385-0738
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013968122300000X
VA0401413862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist