Provider Demographics
NPI:1851699284
Name:RICHVIEW FAMILY DENTISTRY
Entity Type:Organization
Organization Name:RICHVIEW FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALL
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-647-2243
Mailing Address - Street 1:2289 RUDOLPHTOWN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2230
Mailing Address - Country:US
Mailing Address - Phone:931-647-2243
Mailing Address - Fax:931-645-8553
Practice Address - Street 1:2289 RUDOLPHTOWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2230
Practice Address - Country:US
Practice Address - Phone:931-647-2243
Practice Address - Fax:931-645-8553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty