Provider Demographics
NPI:1245498930
Name:RIES ORTHODONTICS
Entity type:Organization
Organization Name:RIES ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-230-6100
Mailing Address - Street 1:333 OZARK TRAIL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2185
Mailing Address - Country:US
Mailing Address - Phone:636-230-6100
Mailing Address - Fax:
Practice Address - Street 1:333 OZARK TRAIL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2185
Practice Address - Country:US
Practice Address - Phone:636-230-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040157761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty