Provider Demographics
NPI:1538296629
Name:RIIS, DOUGLAS NIELSEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:NIELSEN
Last Name:RIIS
Suffix:
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 1:46 WALPOLE ST
Mailing Address - Street 2:PO BOX 70
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-2552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:274 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2403
Practice Address - Country:US
Practice Address - Phone:617-262-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103991223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics