Provider Demographics
NPI:1437324589
Name:RIVERCREST FAMILY DENTAL, P.A.
Entity Type:Organization
Organization Name:RIVERCREST FAMILY DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-625-7611
Mailing Address - Street 1:3029 INDEPENDENCE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4474
Mailing Address - Country:US
Mailing Address - Phone:830-625-7611
Mailing Address - Fax:830-625-7691
Practice Address - Street 1:3029 INDEPENDENCE DR STE 100
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4474
Practice Address - Country:US
Practice Address - Phone:830-625-7611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21504122300000X
TX8451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty