Provider Demographics
NPI:1649564519
Name:RC DENTAL, LLC
Entity Type:Organization
Organization Name:RC DENTAL, LLC
Other - Org Name:RIVER CITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SORHUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-335-0363
Mailing Address - Street 1:120 TRADING BAY RD.
Mailing Address - Street 2:#280
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611
Mailing Address - Country:US
Mailing Address - Phone:907-335-0363
Mailing Address - Fax:907-335-0364
Practice Address - Street 1:120 TRADING BAY RD.
Practice Address - Street 2:#280
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611
Practice Address - Country:US
Practice Address - Phone:907-335-0363
Practice Address - Fax:907-335-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1573792Medicaid