Provider Demographics
NPI:1962427567
Name:RIESZ, TIMOTHY KEITH (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:KEITH
Last Name:RIESZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153 SOUTH TAMIAMI TRAIL
Mailing Address - Street 2:UNIT B
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293
Mailing Address - Country:US
Mailing Address - Phone:650-703-6802
Mailing Address - Fax:
Practice Address - Street 1:4153 TAMIAMI TRL S
Practice Address - Street 2:UNIT B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5122
Practice Address - Country:US
Practice Address - Phone:650-703-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 15792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist