Individual
EVAN RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4040 LONESOME RD, MANDEVILLE, LA 70448
(985) 626-5030
Mailing address
520 TANAGER DR, MANDEVILLE, LA 70448-6100
(504) 756-2047
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6752
LA
Other
Enumeration date
05/25/2017
Last updated
11/06/2019
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