Provider Demographics
NPI:1639132228
Name:RIECK, TERRY RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:RAE
Last Name:RIECK
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 1:2815 BEAVER AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-4063
Mailing Address - Country:US
Mailing Address - Phone:515-255-1195
Mailing Address - Fax:
Practice Address - Street 1:2815 BEAVER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-4063
Practice Address - Country:US
Practice Address - Phone:515-255-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice