Provider Demographics
NPI:1285394965
Name:RIETOW FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:RIETOW FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:RIETOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-806-2956
Mailing Address - Street 1:3175 S ROSEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-9571
Mailing Address - Country:US
Mailing Address - Phone:574-806-2956
Mailing Address - Fax:
Practice Address - Street 1:1259 IN-135 E
Practice Address - Street 2:SUITE E
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142
Practice Address - Country:US
Practice Address - Phone:317-888-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental