Provider Demographics
NPI:1477822484
Name:RIVERPOINT DENTAL
Entity Type:Organization
Organization Name:RIVERPOINT DENTAL
Other - Org Name:GRISEL RINCON DDS, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRISEL
Authorized Official - Middle Name:YUMIRA
Authorized Official - Last Name:RINCON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-281-3000
Mailing Address - Street 1:1730 W FULLERTON AVE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1900
Mailing Address - Country:US
Mailing Address - Phone:773-281-3000
Mailing Address - Fax:773-281-3033
Practice Address - Street 1:1730 W FULLERTON AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1900
Practice Address - Country:US
Practice Address - Phone:773-281-3000
Practice Address - Fax:773-281-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190271181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty