Provider Demographics
NPI:1922770494
Name:RIVERSIDE PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:RIVERSIDE PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ALYSSA
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-284-5267
Mailing Address - Street 1:194 MAIN ST STE 2R
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3609
Mailing Address - Country:US
Mailing Address - Phone:978-378-0408
Mailing Address - Fax:
Practice Address - Street 1:194 MAIN ST STE 2R
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3609
Practice Address - Country:US
Practice Address - Phone:978-378-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty