Provider Demographics
NPI:1669803417
Name:RIEL DENTAL PC
Entity type:Organization
Organization Name:RIEL DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-545-2909
Mailing Address - Street 1:2323 CLEAR LAKE CITY BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-8120
Mailing Address - Country:US
Mailing Address - Phone:281-488-3626
Mailing Address - Fax:
Practice Address - Street 1:2323 CLEAR LAKE CITY BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-8120
Practice Address - Country:US
Practice Address - Phone:281-488-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28670261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental