Provider Demographics
NPI:1992410518
Name:RILEY, MADISON ANNE (DDS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ANNE
Last Name:RILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 W CAMPBELL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3398
Mailing Address - Country:US
Mailing Address - Phone:469-942-7222
Mailing Address - Fax:
Practice Address - Street 1:670 W CAMPBELL RD STE 150
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3398
Practice Address - Country:US
Practice Address - Phone:214-662-8305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX387481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice