Provider Demographics
NPI:1942919139
Name:RIVERVIEW DENTAL PLLC
Entity Type:Organization
Organization Name:RIVERVIEW DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-571-5678
Mailing Address - Street 1:1175 E PARKCENTER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6752
Mailing Address - Country:US
Mailing Address - Phone:208-888-5544
Mailing Address - Fax:
Practice Address - Street 1:1175 E PARKCENTER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6752
Practice Address - Country:US
Practice Address - Phone:208-888-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERVIEW DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental