Provider Demographics
NPI:1841300688
Name:TERRANCE P RILEY DDS PC
Entity type:Organization
Organization Name:TERRANCE P RILEY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-331-1716
Mailing Address - Street 1:2441 CORAL CT STE 2
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2872
Mailing Address - Country:US
Mailing Address - Phone:319-337-2599
Mailing Address - Fax:319-337-7948
Practice Address - Street 1:5345 SPRING ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2764
Practice Address - Country:US
Practice Address - Phone:319-337-2599
Practice Address - Fax:319-337-7948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COS137122300000X
1223X2210X, 332B00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty