Provider Demographics
NPI:1568565687
Name:RIESER, CONNIE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:C
Last Name:RIESER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 JEFFERSON ST
Mailing Address - Street 2:STE. 308
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-6449
Mailing Address - Country:US
Mailing Address - Phone:636-239-7654
Mailing Address - Fax:
Practice Address - Street 1:1351 JEFFERSON ST
Practice Address - Street 2:STE. 308
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-6449
Practice Address - Country:US
Practice Address - Phone:636-239-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist