# MARK A RIESE DDS PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1538858501
- **Authorized official:** MARK A RIESE DDS (DENTIST/OWNER)
- **Authorized official phone:** (574) 583-5042

## Contact information

- **Practice address:** 401 W BROADWAY ST, MONTICELLO, IN 47960-2004
- **Practice address phone:** (574) 583-5042
- **Mailing address:** 401 W BROADWAY ST, MONTICELLO, IN 47960-2004
- **Mailing address phone:** (574) 583-5042

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 05/04/2023
- **Last updated:** 05/04/2023