Provider Demographics
NPI:1790893717
Name:RIVERSBEND DENTAL INC.
Entity Type:Organization
Organization Name:RIVERSBEND DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-494-0333
Mailing Address - Street 1:6028 S STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8280
Mailing Address - Country:US
Mailing Address - Phone:513-494-0333
Mailing Address - Fax:513-494-0222
Practice Address - Street 1:6028 S STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8280
Practice Address - Country:US
Practice Address - Phone:513-494-0333
Practice Address - Fax:513-494-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH190821223G0001X
OH187601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty