Provider Demographics
NPI:1720078371
Name:RILEY, DONALD DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DEAN
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 1:1310 CROWN DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2526
Mailing Address - Country:US
Mailing Address - Phone:660-665-4015
Mailing Address - Fax:660-665-8619
Practice Address - Street 1:1310 CROWN DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2526
Practice Address - Country:US
Practice Address - Phone:660-665-4015
Practice Address - Fax:660-665-8619
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist