Provider Demographics
NPI:1235722737
Name:RIVER TOWN DENTAL CORPORATION
Entity Type:Organization
Organization Name:RIVER TOWN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-626-2550
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-0039
Mailing Address - Country:US
Mailing Address - Phone:406-827-4681
Mailing Address - Fax:406-827-4781
Practice Address - Street 1:1608 MAIN STREET
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-5987
Practice Address - Country:US
Practice Address - Phone:406-827-4681
Practice Address - Fax:406-827-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty