Provider Demographics
NPI:1568503902
Name:ASSOCIATED RIVERBEND DENTISTS PC
Entity Type:Organization
Organization Name:ASSOCIATED RIVERBEND DENTISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:SURGUY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-234-1700
Mailing Address - Street 1:521 EAST MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-2325
Mailing Address - Country:US
Mailing Address - Phone:574-234-1700
Mailing Address - Fax:574-287-6453
Practice Address - Street 1:521 EAST MONROE STREET
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2325
Practice Address - Country:US
Practice Address - Phone:574-234-1700
Practice Address - Fax:574-287-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty