Provider Demographics
NPI:1497784342
Name:RIVER HILLS DENTAL
Entity Type:Organization
Organization Name:RIVER HILLS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SANFORD
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-452-9453
Mailing Address - Street 1:720 E HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5300
Mailing Address - Country:US
Mailing Address - Phone:507-452-9453
Mailing Address - Fax:
Practice Address - Street 1:720 E HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5300
Practice Address - Country:US
Practice Address - Phone:507-452-9453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND98991223G0001X
MND84061223G0001X
MND115681223G0001X
MND104821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty