Provider Demographics
NPI:1407030430
Name:RIVERVIEW FAMILY DENTAL PC
Entity Type:Organization
Organization Name:RIVERVIEW FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-235-6075
Mailing Address - Street 1:100 4TH STREET S #304
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1937
Mailing Address - Country:US
Mailing Address - Phone:701-235-6075
Mailing Address - Fax:701-239-0140
Practice Address - Street 1:100 4TH STREET S #304
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1937
Practice Address - Country:US
Practice Address - Phone:701-235-6075
Practice Address - Fax:701-239-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental