Active NPI
Rietz Dental Management Corporation
- General Practice Dentistry
- Walla Walla, WA
National Provider Identifier
1295947463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE00006530
- Legal business name
- RIETZ DENTAL MANAGEMENT CORPORATION
- Practice address
- 208 South Park St
Walla Walla, WA 99362-3247 - Phone
- (509) 522-0499
- Fax
- (509) 522-0593
- NPI assigned
- May 3, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Douglas W Rietz, D.M.D.
- Title
- Owner
- Phone
- (509) 522-0499
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE00006530 | WA | Primary |
Addresses
Primary practice location
208 South Park St
Walla Walla, WA 99362-3247
Mailing address
208 South Park St
Walla Walla, WA 99362-3247
Phone (509) 522-0499
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56530 | Other | WA | WASHINGTON DENTAL SVC |
| UNTITED CONCORDIA | Other | WA | 00762606 |
| 5017033 | Medicaid | WA |
National Provider Directory
National Provider DirectoryLocations
208 S Park St
Walla Walla, WA 99362
Phone (509) 522-0499
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Walla Walla, WA
- NPI 1265501233
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1295947463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 SOUTH PARK ST",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993623247",
"telephone_number": "509-522-0499",
"fax_number": "509-522-0593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 SOUTH PARK ST",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993623247",
"telephone_number": "509-522-0499",
"fax_number": "509-522-0593"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RIETZ DENTAL MANAGEMENT CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-03",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "RIETZ",
"authorized_official_first_name": "DOUGLAS",
"authorized_official_middle_name": "W",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "509-522-0499",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.M.D."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE00006530",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON DENTAL SVC",
"identifier": "56530",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "00762606",
"identifier": "UNTITED CONCORDIA",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5017033",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Walla Walla, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.