Provider Demographics
NPI:1679868095
Name:RIEGEL, RHAE ANNA L (DMD)
Entity Type:Individual
Prefix:
First Name:RHAE ANNA
Middle Name:L
Last Name:RIEGEL
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 1:1004 S STATE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6925
Mailing Address - Country:US
Mailing Address - Phone:302-674-4450
Mailing Address - Fax:
Practice Address - Street 1:1004 S STATE ST STE 1
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6925
Practice Address - Country:US
Practice Address - Phone:302-674-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DEG1-00013941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program