Provider Demographics
NPI:1215508742
Name:RIESGRAF, EMILY GRACE (DDS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:RIESGRAF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST STE L
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1839
Mailing Address - Country:US
Mailing Address - Phone:651-399-3744
Mailing Address - Fax:
Practice Address - Street 1:2001 S SHIELDS ST STE L
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1839
Practice Address - Country:US
Practice Address - Phone:970-221-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist