Organization
RIETZ DENTAL MANAGEMENT CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS W RIETZ D.M.D. (OWNER)
(509) 522-0499
Entity
Organization
Contact information
Practice address
208 SOUTH PARK ST, WALLA WALLA, WA 99362-3247
(509) 522-0499
(509) 522-0593
Mailing address
208 SOUTH PARK ST, WALLA WALLA, WA 99362-3247
(509) 522-0499
(509) 522-0593
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00006530
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5017033
—
WA
01
—
56530
WASHINGTON DENTAL SVC
WA
01
—
UNTITED CONCORDIA
00762606
WA
Enumeration date
05/03/2007
Last updated
08/22/2020
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