Provider Demographics
NPI:1578272548
Name:RIELO DENTAL CLINIC
Entity Type:Organization
Organization Name:RIELO DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIELO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-375-1782
Mailing Address - Street 1:5376 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2165
Mailing Address - Country:US
Mailing Address - Phone:305-231-5455
Mailing Address - Fax:305-749-0980
Practice Address - Street 1:5376 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2165
Practice Address - Country:US
Practice Address - Phone:305-231-5455
Practice Address - Fax:305-749-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103860400Medicaid