Provider Demographics
NPI:1386762631
Name:RIEGEL, ROBERT CLARK (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLARK
Last Name:RIEGEL
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5642 S EASTERN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2310
Mailing Address - Country:US
Mailing Address - Phone:702-436-6186
Mailing Address - Fax:702-436-3276
Practice Address - Street 1:5642 S EASTERN AVE STE F
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-436-6186
Practice Address - Fax:702-436-3276
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20576122300000X
NVS5-13122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1225524960OtherNPI