Provider Demographics
NPI:1609164011
Name:SONRIESZA ENTERPRISES LLC
Entity Type:Organization
Organization Name:SONRIESZA ENTERPRISES LLC
Other - Org Name:VENICE VILLAGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:RIESZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-408-7645
Mailing Address - Street 1:4153 UNIT B SOUTH TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293
Mailing Address - Country:US
Mailing Address - Phone:941-408-7645
Mailing Address - Fax:941-408-7660
Practice Address - Street 1:4153 UNIT B SOUTH TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293
Practice Address - Country:US
Practice Address - Phone:941-408-7645
Practice Address - Fax:941-408-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty