Provider Demographics
NPI:1902972029
Name:RILEY, DANIEL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:RILEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 SEIDEL RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3033
Mailing Address - Country:US
Mailing Address - Phone:210-828-5300
Mailing Address - Fax:
Practice Address - Street 1:7700 BROADWAY ST
Practice Address - Street 2:102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3232
Practice Address - Country:US
Practice Address - Phone:210-828-5300
Practice Address - Fax:210-828-3205
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice