Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 019-031876 | IL |
NPI | 1346724341 |
---|---|
Provider Name | Ryan Stanley Riggs |
First Address | Quincy, IL 62301-2700 |
Second Address | Quincy, IL 62301-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2018 |
Last Update Date | 17/09/2018 |