Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1164649182 |
---|---|
Provider Name | Mr. Ricardo Riojas |
First Address | Denver, CO 80221-1506 |
Second Address | Lakewood, CO 80214-5730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |