Provider Demographics
NPI:1043761398
Name:RIVERBEND ENDODONTICS
Entity Type:Organization
Organization Name:RIVERBEND ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN NIEUWENHUYZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:563-209-9041
Mailing Address - Street 1:2550 MIDDLE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7905
Mailing Address - Country:US
Mailing Address - Phone:563-209-9041
Mailing Address - Fax:563-209-9042
Practice Address - Street 1:2550 MIDDLE RD
Practice Address - Street 2:STE 101
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7905
Practice Address - Country:US
Practice Address - Phone:563-209-9041
Practice Address - Fax:563-209-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09335261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental