Provider Demographics
NPI:1336559475
Name:WEDLAKE, RILEY (DMD)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:WEDLAKE
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 1:84 LEFURGY AVE
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1206
Mailing Address - Country:US
Mailing Address - Phone:509-994-9119
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK DR STE 6
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1966
Practice Address - Country:US
Practice Address - Phone:845-675-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0596471223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program