Provider Demographics
NPI:1457476483
Name:RILEY, DAVID WARE (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WARE
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:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-0828
Mailing Address - Country:US
Mailing Address - Phone:434-332-5919
Mailing Address - Fax:434-332-1740
Practice Address - Street 1:1052 VILLAGE HWY
Practice Address - Street 2:
Practice Address - City:RUSTBURG
Practice Address - State:VA
Practice Address - Zip Code:24588
Practice Address - Country:US
Practice Address - Phone:434-332-5919
Practice Address - Fax:434-332-1740
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010056551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice