Provider Demographics
NPI:1609378231
Name:RIVOLI DENTAL OF GLENS FALLS PC
Entity Type:Organization
Organization Name:RIVOLI DENTAL OF GLENS FALLS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZEMBIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-278-1017
Mailing Address - Street 1:77 NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2156
Mailing Address - Country:US
Mailing Address - Phone:585-278-1000
Mailing Address - Fax:585-352-3211
Practice Address - Street 1:54 SANFORD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2928
Practice Address - Country:US
Practice Address - Phone:518-793-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty