| Rietz Dental Management Corporation | |
|
208 South Park St Walla Walla WA 99362-3247 | |
| (509) 522-0499 | |
| (509) 522-0593 |
| Full Name | Rietz Dental Management Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 208 South Park St, Walla Walla, Washington |
| Authorized Official Name and Position | Douglas W Rietz (OWNER) |
| Authorized Official Contact | 5095220499 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rietz Dental Management Corporation 208 South Park St Walla Walla WA 99362-3247 Ph: (509) 522-0499 | Rietz Dental Management Corporation 208 South Park St Walla Walla WA 99362-3247 Ph: (509) 522-0499 |
| NPI Number | 1295947463 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295947463 | NPI | - | NPPES |
| 56530 | Other | WA | WASHINGTON DENTAL SVC |
| UNTITED CONCORDIA | Other | WA | 00762606 |
| 5017033 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE00006530 (Washington) | Primary |
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