Provider Demographics
NPI:1851602833
Name:RIESEN, JULIE ELIZABETH (DENTAL HYGENIST)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ELIZABETH
Last Name:RIESEN
Suffix:
Gender:F
Credentials:DENTAL HYGENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 PINEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-5503
Mailing Address - Country:US
Mailing Address - Phone:308-432-5123
Mailing Address - Fax:308-432-8126
Practice Address - Street 1:221 CHADRON AVE
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2347
Practice Address - Country:US
Practice Address - Phone:308-432-8124
Practice Address - Fax:308-432-8126
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE775124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist