Provider Demographics
NPI:1023981149
Name:RILEY, SHELLY R
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:R
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N RIVERPOINT BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1610
Mailing Address - Country:US
Mailing Address - Phone:509-828-1300
Mailing Address - Fax:
Practice Address - Street 1:13422 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0662
Practice Address - Country:US
Practice Address - Phone:509-425-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist