Provider Demographics
NPI:1982992616
Name:CHRISTOPHER W. RIEDEL, DDS, PA
Entity type:Organization
Organization Name:CHRISTOPHER W. RIEDEL, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:RIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-882-9304
Mailing Address - Street 1:16453 HIGHWAY 62 S
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-1986
Mailing Address - Country:US
Mailing Address - Phone:409-882-9304
Mailing Address - Fax:409-670-1039
Practice Address - Street 1:16453 HIGHWAY 62 S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-1986
Practice Address - Country:US
Practice Address - Phone:409-882-9304
Practice Address - Fax:409-670-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty