Provider Demographics
NPI:1245337625
Name:RIRIE, ROBERT S (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:RIRIE
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 1:7878 W USTICK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5006
Mailing Address - Country:US
Mailing Address - Phone:208-376-2920
Mailing Address - Fax:208-376-8509
Practice Address - Street 1:7878 W USTICK RD STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5006
Practice Address - Country:US
Practice Address - Phone:208-376-2920
Practice Address - Fax:208-376-8509
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist