Individual
DR. ELLEN CAMILLE RIEBSOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1324 TIPPECANOE ST, LAFAYETTE, IN 47904-2051
(765) 742-1567
Mailing address
1324 TIPPECANOE ST, LAFAYETTE, IN 47904-2051
(765) 742-1567
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011346A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200967490
—
IN
Enumeration date
05/10/2010
Last updated
02/13/2017
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