Organization
RIYAN DENTAL LLC
Active
Other names
WEST EDGEWOOD DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJENDAR MATTA DMD (PRESIDENT)
(205) 617-7417
Entity
Organization
Contact information
Practice address
3306 EMERALD LN, JEFFERSON CITY, MO 65109-6880
(573) 634-2222
Mailing address
14031 WILLOW DR, CLIVE, IA 50325-8317
(205) 617-7417
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/10/2022
Last updated
03/09/2022
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