Provider Demographics
NPI:1407903834
Name:RIVERGLEN DENTAL GROUP
Entity Type:Organization
Organization Name:RIVERGLEN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-885-0227
Mailing Address - Street 1:5830 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3959
Mailing Address - Country:US
Mailing Address - Phone:614-885-0227
Mailing Address - Fax:614-885-1534
Practice Address - Street 1:5830 N HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3959
Practice Address - Country:US
Practice Address - Phone:614-885-0227
Practice Address - Fax:614-885-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty