Provider Demographics
NPI:1982203584
Name:CRYSTEL ANANOS RIGGS DMD PA
Entity Type:Organization
Organization Name:CRYSTEL ANANOS RIGGS DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTEL
Authorized Official - Middle Name:ANANOS
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-220-4171
Mailing Address - Street 1:900 SE OCEAN BLVD STE 248
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3501
Mailing Address - Country:US
Mailing Address - Phone:772-220-4171
Mailing Address - Fax:
Practice Address - Street 1:900 SE OCEAN BLVD STE 248
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3501
Practice Address - Country:US
Practice Address - Phone:772-220-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty