Provider Demographics
NPI:1730478470
Name:RIVERBEND DENTAL LLC
Entity Type:Organization
Organization Name:RIVERBEND DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-692-1110
Mailing Address - Street 1:1922 EDWARDSVILLE CLUB PLAZA
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025
Mailing Address - Country:US
Mailing Address - Phone:888-502-7339
Mailing Address - Fax:
Practice Address - Street 1:215 E CENTER DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-462-3330
Practice Address - Fax:618-462-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190252811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty