Provider Demographics
NPI:1669593679
Name:RILEY, CHRISTINA (RDH)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 DANA RD
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1535
Mailing Address - Country:US
Mailing Address - Phone:781-878-6228
Mailing Address - Fax:
Practice Address - Street 1:15 WARREN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4015
Practice Address - Country:US
Practice Address - Phone:781-963-3800
Practice Address - Fax:781-963-6906
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13426124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist