Provider Demographics
NPI:1780491035
Name:RIVEDALE DENTAL CENTER LLC
Entity type:Organization
Organization Name:RIVEDALE DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMBARASHE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIRENYATWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-449-5540
Mailing Address - Street 1:6309 BALTIMORE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1059
Mailing Address - Country:US
Mailing Address - Phone:240-449-5540
Mailing Address - Fax:
Practice Address - Street 1:6309 BALTIMORE AVE STE 303
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1059
Practice Address - Country:US
Practice Address - Phone:240-449-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty