Provider Demographics
NPI:1740660919
Name:RIVERDALE DENTAL CENTRE
Entity type:Organization
Organization Name:RIVERDALE DENTAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-659-1920
Mailing Address - Street 1:15 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2128
Mailing Address - Country:US
Mailing Address - Phone:303-659-1820
Mailing Address - Fax:303-659-9191
Practice Address - Street 1:15 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2128
Practice Address - Country:US
Practice Address - Phone:303-659-1920
Practice Address - Fax:303-659-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO014147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty