Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 28798 | CA |
NPI | 1740284793 |
---|---|
Provider Name | Dr. Stephen Jay Riggio |
First Address | Tuolumne, CA 95379-2080 |
Second Address | Jackson, CA 95642-9344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 08/07/2007 |