# RIETZ DENTAL MANAGEMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295947463
- **Authorized official:** DR. DOUGLAS W RIETZ D.M.D. (OWNER)
- **Authorized official phone:** (509) 522-0499

## Contact information

- **Practice address:** 208 SOUTH PARK ST, WALLA WALLA, WA 99362-3247
- **Practice address phone:** (509) 522-0499
- **Practice address fax:** (509) 522-0593
- **Mailing address:** 208 SOUTH PARK ST, WALLA WALLA, WA 99362-3247
- **Mailing address phone:** (509) 522-0499
- **Mailing address fax:** (509) 522-0593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00006530 | WA | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5017033 | — | WA |
| 01 | — | 56530 | WASHINGTON DENTAL SVC | WA |
| 01 | — | UNTITED CONCORDIA | 00762606 | WA |