Provider Demographics
NPI:1538638002
Name:RIVERSIDE CENTER FOR FAMILY AND COSMETIC DENTITRY
Entity Type:Organization
Organization Name:RIVERSIDE CENTER FOR FAMILY AND COSMETIC DENTITRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS-HEYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:505-922-6000
Mailing Address - Street 1:2600 AMERICAN RD SE STE 230
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1858
Mailing Address - Country:US
Mailing Address - Phone:505-922-6000
Mailing Address - Fax:505-922-6363
Practice Address - Street 1:2600 AMERICAN RD SE STE 230
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1858
Practice Address - Country:US
Practice Address - Phone:505-922-6000
Practice Address - Fax:505-922-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental