Provider Demographics
NPI:1750500427
Name:RIESSELMAN, PHILLIP (DDS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:RIESSELMAN
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 1:6262 S PARKER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1257
Mailing Address - Country:US
Mailing Address - Phone:303-690-4500
Mailing Address - Fax:
Practice Address - Street 1:6262 S PARKER RD
Practice Address - Street 2:STE 300
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-1257
Practice Address - Country:US
Practice Address - Phone:303-690-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1009761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice