Provider Demographics
NPI:1619984499
Name:RIEKER, BRYAN JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:RIEKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 HURON STREET
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NORTH GLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4378
Mailing Address - Country:US
Mailing Address - Phone:303-452-9200
Mailing Address - Fax:303-452-9400
Practice Address - Street 1:11150 HURON STREET
Practice Address - Street 2:SUITE 211
Practice Address - City:NORTH GLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4378
Practice Address - Country:US
Practice Address - Phone:303-452-9200
Practice Address - Fax:303-452-9400
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist