Provider Demographics
NPI:1760568349
Name:RISSER, WILLIAM RACKLIFF (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RACKLIFF
Last Name:RISSER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412
Mailing Address - Country:US
Mailing Address - Phone:207-989-1952
Mailing Address - Fax:207-989-1956
Practice Address - Street 1:182 WILSON ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-989-1952
Practice Address - Fax:207-989-1956
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME29731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2398647OtherDEA LICENSE NUMBER