Provider Demographics
NPI:1659718963
Name:RIESCHICK, SAMANTHA CRUZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:CRUZ
Last Name:RIESCHICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 COLUMBINE DR
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8841
Mailing Address - Country:US
Mailing Address - Phone:785-364-3038
Mailing Address - Fax:785-364-3037
Practice Address - Street 1:1100 COLUMBINE DR
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8841
Practice Address - Country:US
Practice Address - Phone:785-364-3038
Practice Address - Fax:785-364-3037
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS609621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice