Provider Demographics
NPI:1215922760
Name:RILEY, IRVING NORFLIN (DDS)
Entity type:Individual
Prefix:DR
First Name:IRVING
Middle Name:NORFLIN
Last Name:RILEY
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 1:301 ALAMO DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4246
Mailing Address - Country:US
Mailing Address - Phone:707-447-0989
Mailing Address - Fax:707-447-6829
Practice Address - Street 1:301 ALAMO DR
Practice Address - Street 2:SUITE E
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4246
Practice Address - Country:US
Practice Address - Phone:707-447-0989
Practice Address - Fax:707-447-6829
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0154221223S0112X
CA591291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103322661Medicaid
MI103322661Medicaid
MI0M32740Medicare PIN