Provider Demographics
NPI:1851883284
Name:RIVERS END DENTAL
Entity Type:Organization
Organization Name:RIVERS END DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-639-1500
Mailing Address - Street 1:148 DRUMLIN CIR
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2588
Mailing Address - Country:US
Mailing Address - Phone:970-639-1500
Mailing Address - Fax:
Practice Address - Street 1:532 RAPTOR ROAD
Practice Address - Street 2:UNIT B
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521
Practice Address - Country:US
Practice Address - Phone:970-639-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00010764261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental