Provider Demographics
NPI:1255545539
Name:RILEY, CHRISTOPHER KENT (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KENT
Last Name:RILEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:KENT
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9535 ALIBAMUS CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-8393
Mailing Address - Country:US
Mailing Address - Phone:561-531-3161
Mailing Address - Fax:
Practice Address - Street 1:9535 ALIBAMUS CT
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-8393
Practice Address - Country:US
Practice Address - Phone:561-531-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160571223G0001X
ALD 5812 C1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice