Provider Demographics
NPI:1003426792
Name:RIVERVIEW FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:RIVERVIEW FAMILY DENTAL, PLLC
Other - Org Name:RIVERVIEW FAMILY DENTAL, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-453-3314
Mailing Address - Street 1:9428 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958
Mailing Address - Country:US
Mailing Address - Phone:772-783-3896
Mailing Address - Fax:
Practice Address - Street 1:9428 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958
Practice Address - Country:US
Practice Address - Phone:772-783-3896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty