Provider Demographics
NPI:1952962888
Name:RILEY, KALYN JANECE (DDS)
Entity type:Individual
Prefix:DR
First Name:KALYN
Middle Name:JANECE
Last Name:RILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 COUNTY ROAD 461B
Mailing Address - Street 2:
Mailing Address - City:BRAZORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77422-6505
Mailing Address - Country:US
Mailing Address - Phone:979-665-6588
Mailing Address - Fax:
Practice Address - Street 1:505 DANCE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-4019
Practice Address - Country:US
Practice Address - Phone:979-665-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty