Provider Demographics
NPI:1245419308
Name:RIVERSIDE DENTAL P.C.
Entity Type:Organization
Organization Name:RIVERSIDE DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LA MADRID
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-299-4470
Mailing Address - Street 1:1640 E RIVER RD STE 112
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-7645
Mailing Address - Country:US
Mailing Address - Phone:520-299-4470
Mailing Address - Fax:520-299-4475
Practice Address - Street 1:1640 E RIVER RD STE 112
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-7645
Practice Address - Country:US
Practice Address - Phone:520-299-4470
Practice Address - Fax:520-299-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD52251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty