Individual
DR. BROCK RIEDEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
862 LEXINGTON ST, WALTHAM, MA 02452-4849
(781) 684-9714
Mailing address
55 WEST 5TH, APT 605, BOSTON, MA 02127
(785) 320-1841
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1859503
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/07/2022
Last updated
08/02/2022
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