Provider Demographics
NPI:1851541403
Name:RIVERVIEW COMMUNITY DENTAL CLINIC
Entity Type:Organization
Organization Name:RIVERVIEW COMMUNITY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CELSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-421-7410
Mailing Address - Street 1:420 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4714
Mailing Address - Country:US
Mailing Address - Phone:715-422-7750
Mailing Address - Fax:715-424-9027
Practice Address - Street 1:1160 ROME CENTER DR
Practice Address - Street 2:
Practice Address - City:NEKOOSA
Practice Address - State:WI
Practice Address - Zip Code:54457
Practice Address - Country:US
Practice Address - Phone:715-422-7750
Practice Address - Fax:715-424-9027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERVIEW HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty