Provider Demographics
NPI:1366741530
Name:RIORDAN, DONNA MARIE (RDH)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 MAIN ST NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7409
Mailing Address - Country:US
Mailing Address - Phone:505-565-0609
Mailing Address - Fax:505-565-0709
Practice Address - Street 1:1204 MAIN ST NE
Practice Address - Street 2:SUITE B
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7409
Practice Address - Country:US
Practice Address - Phone:505-565-0609
Practice Address - Fax:505-565-0709
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH373124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist