Provider Demographics
NPI:1619020948
Name:RIVER VALLY DENTAL-FACIAL IMAGING LLC
Entity Type:Organization
Organization Name:RIVER VALLY DENTAL-FACIAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-484-0200
Mailing Address - Street 1:2713 S 74TH ST
Mailing Address - Street 2:STE 203
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5170
Mailing Address - Country:US
Mailing Address - Phone:479-484-0200
Mailing Address - Fax:479-484-5908
Practice Address - Street 1:2713 S 74TH ST
Practice Address - Street 2:STE 203
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5170
Practice Address - Country:US
Practice Address - Phone:479-484-0200
Practice Address - Fax:479-484-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21621223G0001X
AR20741223S0112X
AR31731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty