Provider Demographics
NPI:1922105360
Name:RIEFKOHL, WALDEMAR RICARDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALDEMAR
Middle Name:RICARDO
Last Name:RIEFKOHL
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 1:4010 NW 67TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-8353
Mailing Address - Country:US
Mailing Address - Phone:352-374-7078
Mailing Address - Fax:
Practice Address - Street 1:RECEPTION AND MEDICAL CENTER
Practice Address - Street 2:HWY 231
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-0628
Practice Address - Country:US
Practice Address - Phone:386-496-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 113471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice