Provider Demographics
NPI:1598336380
Name:COUSIN & RIOLO DDS PLLC
Entity Type:Organization
Organization Name:COUSIN & RIOLO DDS PLLC
Other - Org Name:BELLEVUE ORTHODONTICS AND SMILE DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRIDGFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-355-3395
Mailing Address - Street 1:1515 116TH AVE NE, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-382-7559
Mailing Address - Fax:
Practice Address - Street 1:1515 116TH AVE NE, SUITE 105
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-382-7559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty