Provider Demographics
NPI:1730617184
Name:RIETZE, DAYNA ANN (RDH)
Entity type:Individual
Prefix:MS
First Name:DAYNA
Middle Name:ANN
Last Name:RIETZE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:DAYNA
Other - Middle Name:ANN
Other - Last Name:BURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1718 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-6806
Mailing Address - Country:US
Mailing Address - Phone:360-477-1085
Mailing Address - Fax:
Practice Address - Street 1:104 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2825
Practice Address - Country:US
Practice Address - Phone:360-452-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60609958124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist