Provider Demographics
NPI:1194920942
Name:RIEBACK, SETH HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:HOWARD
Last Name:RIEBACK
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 1:2600 N MILITARY TRL
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6312
Mailing Address - Country:US
Mailing Address - Phone:561-241-9440
Mailing Address - Fax:561-241-4922
Practice Address - Street 1:2600 N MILITARY TRL
Practice Address - Street 2:SUITE 330
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6312
Practice Address - Country:US
Practice Address - Phone:561-241-9440
Practice Address - Fax:561-241-4922
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL61141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics