Provider Demographics
NPI:1598134801
Name:RIVERDALE URGENT CARE DENTAL, LLC
Entity Type:Organization
Organization Name:RIVERDALE URGENT CARE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOESER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-769-0799
Mailing Address - Street 1:3509 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1602
Mailing Address - Country:US
Mailing Address - Phone:914-769-0799
Mailing Address - Fax:914-769-5011
Practice Address - Street 1:3509 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1602
Practice Address - Country:US
Practice Address - Phone:914-769-0799
Practice Address - Fax:914-769-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0491001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty