Provider Demographics
NPI:1629470380
Name:RIEHS PEDIATRIC DENTAL PC
Entity Type:Organization
Organization Name:RIEHS PEDIATRIC DENTAL PC
Other - Org Name:FLOSS KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:RIEHS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-244-4159
Mailing Address - Street 1:9440 MONTELEON CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-5869
Mailing Address - Country:US
Mailing Address - Phone:214-244-4159
Mailing Address - Fax:214-871-7110
Practice Address - Street 1:8335 WESTCHESTER DRIVE
Practice Address - Street 2:SUITE 152
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5718
Practice Address - Country:US
Practice Address - Phone:214-244-4159
Practice Address - Fax:214-871-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty