Provider Demographics
NPI:1568634087
Name:RIVERVIEW DENTAL CARE
Entity Type:Organization
Organization Name:RIVERVIEW DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-375-6735
Mailing Address - Street 1:50 RIVERDALE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-375-6735
Mailing Address - Fax:914-375-7456
Practice Address - Street 1:50 RIVERDALE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-375-6735
Practice Address - Fax:914-375-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01474033Medicaid