Provider Demographics
NPI:1851015275
Name:JAMILA RILEY DDS LLC
Entity Type:Organization
Organization Name:JAMILA RILEY DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:SHANI MCKINNIS
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-622-6504
Mailing Address - Street 1:3412 GRENADIER CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-6220
Mailing Address - Country:US
Mailing Address - Phone:251-622-6504
Mailing Address - Fax:
Practice Address - Street 1:3805 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1619
Practice Address - Country:US
Practice Address - Phone:251-343-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental