Provider Demographics
NPI:1992866719
Name:RIECK, LAWRENCE E (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:RIECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49468-0092
Mailing Address - Country:US
Mailing Address - Phone:616-534-0080
Mailing Address - Fax:616-534-2165
Practice Address - Street 1:3055 44TH ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2501
Practice Address - Country:US
Practice Address - Phone:616-534-0080
Practice Address - Fax:616-534-2165
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0123391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice