Provider Demographics
NPI:1093927584
Name:RIVCO LEASERVICE
Entity Type:Organization
Organization Name:RIVCO LEASERVICE
Other - Org Name:STUDIO CITY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-506-2424
Mailing Address - Street 1:12840 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:818-506-2424
Mailing Address - Fax:818-763-5679
Practice Address - Street 1:12840 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 508
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607
Practice Address - Country:US
Practice Address - Phone:818-506-2424
Practice Address - Fax:818-763-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty