Provider Demographics
NPI:1598022170
Name:RIVARD & RUDER DDS PC
Entity Type:Organization
Organization Name:RIVARD & RUDER DDS PC
Other - Org Name:HEALTHY SMILE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-628-2737
Mailing Address - Street 1:171 S PLATTE CLAY WAY
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-7649
Mailing Address - Country:US
Mailing Address - Phone:816-628-2737
Mailing Address - Fax:816-903-2770
Practice Address - Street 1:171 S PLATTE CLAY WAY
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7649
Practice Address - Country:US
Practice Address - Phone:816-628-2737
Practice Address - Fax:816-903-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty