Provider Demographics
NPI:1164763553
Name:RIVER HILL DENTAL
Entity Type:Organization
Organization Name:RIVER HILL DENTAL
Other - Org Name:BRENTLY H. STICE ESTATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-424-8246
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-0508
Mailing Address - Country:US
Mailing Address - Phone:270-597-3711
Mailing Address - Fax:270-597-2032
Practice Address - Street 1:1427 KY HIGHWAY 259 N
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-9280
Practice Address - Country:US
Practice Address - Phone:502-597-3711
Practice Address - Fax:502-597-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59081223G0001X
KY58551223G0001X
KY69201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60059086Medicaid