Provider Demographics
NPI:1740284793
Name:RIGGIO, STEPHEN JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAY
Last Name:RIGGIO
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 2080
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-2080
Mailing Address - Country:US
Mailing Address - Phone:209-928-4277
Mailing Address - Fax:209-928-1295
Practice Address - Street 1:15515 DALTONS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9344
Practice Address - Country:US
Practice Address - Phone:209-223-8460
Practice Address - Fax:209-223-8464
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287981223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health