Provider Demographics
NPI:1528209491
Name:RIORDAN, ANDREA M (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:RIORDAN
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 1:5800 STANFORD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4385
Mailing Address - Country:US
Mailing Address - Phone:916-435-4222
Mailing Address - Fax:
Practice Address - Street 1:5800 STANFORD RANCH RD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4385
Practice Address - Country:US
Practice Address - Phone:916-435-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice