Provider Demographics
NPI:1598897100
Name:RILEY, ROCHELLE JENNIFER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:JENNIFER
Last Name:RILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROCHELLE
Other - Middle Name:JENNIFER
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6596 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5615
Mailing Address - Country:US
Mailing Address - Phone:520-297-9069
Mailing Address - Fax:520-575-9600
Practice Address - Street 1:6596 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5615
Practice Address - Country:US
Practice Address - Phone:520-297-9069
Practice Address - Fax:520-575-9600
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist