Provider Demographics
NPI:1417045873
Name:MARK J RIEDLER DDS PC
Entity type:Organization
Organization Name:MARK J RIEDLER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:RIEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-281-6635
Mailing Address - Street 1:4167 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104
Mailing Address - Country:US
Mailing Address - Phone:617-281-6635
Mailing Address - Fax:619-281-7148
Practice Address - Street 1:4167 OHIO ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104
Practice Address - Country:US
Practice Address - Phone:617-281-6635
Practice Address - Fax:619-281-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA028072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty