Provider Demographics
NPI:1013085760
Name:BEIERSDORF, RIECK ALBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:RIECK
Middle Name:ALBERT
Last Name:BEIERSDORF
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 1:11016 E SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:WI
Mailing Address - Zip Code:53063-9745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:62 SOUTH PLEASANT VIEW ROAD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-4954
Practice Address - Country:US
Practice Address - Phone:920-892-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist