Provider Demographics
NPI:1114078094
Name:RIVER VALLEY DENTAL CLINIC, PC
Entity Type:Organization
Organization Name:RIVER VALLEY DENTAL CLINIC, PC
Other - Org Name:GRAND VALLEY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILONI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-744-3007
Mailing Address - Street 1:132 WALNUT AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7483
Mailing Address - Country:US
Mailing Address - Phone:970-242-5151
Mailing Address - Fax:970-255-6664
Practice Address - Street 1:132 WALNUT AVE STE 6
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7483
Practice Address - Country:US
Practice Address - Phone:970-242-5151
Practice Address - Fax:970-255-6664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8541122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty