Mark J Riedler DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

028072 Issued in CA

Legal business name

MARK J RIEDLER DDS PC

Practice address

4167 Ohio St
San Diego, CA 92104

Phone

(617) 281-6635

Fax

(619) 281-7148

NPI assigned

Oct 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Jason Riedler, DDS

Title

Owner

Phone

(619) 281-6635

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417045873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4167 OHIO ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92104",
            "telephone_number": "617-281-6635",
            "fax_number": "619-281-7148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4167 OHIO ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92104",
            "telephone_number": "617-281-6635",
            "fax_number": "619-281-7148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK J RIEDLER DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RIEDLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-281-6635",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "028072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in San Diego, CA
• Providers in San Diego, CA by specialty
• Dentist in California

• 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.

Verify at the official NPI Registry.