Provider Demographics
NPI:1750352811
Name:RIES, DENNIS D (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:D
Last Name:RIES
Suffix:
Gender:M
Credentials:MD
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 900
Mailing Address - Street 2:
Mailing Address - City:FREEMAN
Mailing Address - State:SD
Mailing Address - Zip Code:57029-0900
Mailing Address - Country:US
Mailing Address - Phone:605-925-4219
Mailing Address - Fax:
Practice Address - Street 1:804 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:FREEMAN
Practice Address - State:SD
Practice Address - Zip Code:57029-0900
Practice Address - Country:US
Practice Address - Phone:605-925-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5603232Medicaid
SD5603230Medicaid
SD5603232Medicaid
SD53190Medicare ID - Type Unspecified
SD59552Medicare ID - Type Unspecified