Provider Demographics
NPI:1598982407
Name:RIVELCO ENTERPRISES, INC.
Entity Type:Organization
Organization Name:RIVELCO ENTERPRISES, INC.
Other - Org Name:LAKEVIEW DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:GURMINDER
Authorized Official - Last Name:SURI
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DDS
Authorized Official - Phone:863-297-5200
Mailing Address - Street 1:814 SPRING LAKE SQ
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1338
Mailing Address - Country:US
Mailing Address - Phone:863-297-5200
Mailing Address - Fax:
Practice Address - Street 1:814 SPRING LAKE SQ
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1338
Practice Address - Country:US
Practice Address - Phone:863-297-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 150691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty