Provider Demographics
NPI:1013001031
Name:RIVER VALLEY ENDODONTICS PA
Entity Type:Organization
Organization Name:RIVER VALLEY ENDODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:S
Authorized Official - Last Name:REEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS PHD
Authorized Official - Phone:651-439-8085
Mailing Address - Street 1:2600 WILD PINES LANE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5420
Mailing Address - Country:US
Mailing Address - Phone:651-439-8085
Mailing Address - Fax:651-439-9705
Practice Address - Street 1:2600 WILD PINES LANE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5420
Practice Address - Country:US
Practice Address - Phone:651-439-8085
Practice Address - Fax:651-439-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND107101223E0200X
MND102811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty