Provider Demographics
NPI:1609953322
Name:RIORDAN, MARYANN THERESA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:THERESA
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 5TH AVE
Mailing Address - Street 2:SUITE MG
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2101
Mailing Address - Country:US
Mailing Address - Phone:212-368-6700
Mailing Address - Fax:212-368-7183
Practice Address - Street 1:2225 5TH AVE
Practice Address - Street 2:SUITE MG
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2101
Practice Address - Country:US
Practice Address - Phone:212-368-6700
Practice Address - Fax:212-368-7183
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02373628Medicaid