Provider Demographics
NPI:1568662906
Name:RILEY, RYAN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:RILEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WATSON POWELL JR WAY
Mailing Address - Street 2:UNIT 515
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1713
Mailing Address - Country:US
Mailing Address - Phone:515-707-5345
Mailing Address - Fax:
Practice Address - Street 1:1111 9TH ST
Practice Address - Street 2:STE 190
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2527
Practice Address - Country:US
Practice Address - Phone:515-244-9136
Practice Address - Fax:515-244-9153
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice