Provider Demographics
NPI:1437329026
Name:RIVIERA DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:RIVIERA DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANCELLOR
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-943-3368
Mailing Address - Street 1:198 COUNTY ROAD 20
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3426
Mailing Address - Country:US
Mailing Address - Phone:251-943-3368
Mailing Address - Fax:251-943-1798
Practice Address - Street 1:198 COUNTY ROAD 20
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3426
Practice Address - Country:US
Practice Address - Phone:251-943-3368
Practice Address - Fax:251-943-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty