Provider Demographics
NPI:1558620997
Name:RILEY & HAN DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:RILEY & HAN DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KING-BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-723-4032
Mailing Address - Street 1:10 HAWTHORNE PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2336
Mailing Address - Country:US
Mailing Address - Phone:617-723-4032
Mailing Address - Fax:617-723-4059
Practice Address - Street 1:10 HAWTHORNE PL
Practice Address - Street 2:SUITE 102
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2336
Practice Address - Country:US
Practice Address - Phone:617-723-4032
Practice Address - Fax:617-723-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN12185261QD0000X
MADN19965261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1043475056OtherDENTIST PRACTIONER NPI TYPE 1
MA1730101767OtherDENTIST TRACTIONER NPI TYPE 1
MA1235213752OtherDENTIST PRACTIONER NPI TYPE 1