Provider Demographics
NPI:1255113932
Name:CATAWBA RIVER DENTISTRY, LLC
Entity type:Organization
Organization Name:CATAWBA RIVER DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONTUORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-396-5888
Mailing Address - Street 1:200 N DOBYS BRIDGE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-2084
Mailing Address - Country:US
Mailing Address - Phone:803-396-5888
Mailing Address - Fax:803-396-5893
Practice Address - Street 1:200 N DOBYS BRIDGE RD STE 108
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-2084
Practice Address - Country:US
Practice Address - Phone:803-396-5888
Practice Address - Fax:803-396-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770100505OtherGENERAL DENTIST