Provider Demographics
NPI:1942504022
Name:RIGGS DENTAL MANAGEMENT PC
Entity Type:Organization
Organization Name:RIGGS DENTAL MANAGEMENT PC
Other - Org Name:SMILES ON RIGGS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KERBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-802-5655
Mailing Address - Street 1:975 E RIGGS RD STE 8
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4260
Mailing Address - Country:US
Mailing Address - Phone:480-802-5655
Mailing Address - Fax:480-802-1233
Practice Address - Street 1:975 E RIGGS RD STE 8
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-4260
Practice Address - Country:US
Practice Address - Phone:480-802-5655
Practice Address - Fax:480-802-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6458122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty