Provider Demographics
NPI:1780790295
Name:RIVERWALK DENTISTRY SC
Entity type:Organization
Organization Name:RIVERWALK DENTISTRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-271-1770
Mailing Address - Street 1:735 N WATER STREET
Mailing Address - Street 2:SUITE 826
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4104
Mailing Address - Country:US
Mailing Address - Phone:414-271-1770
Mailing Address - Fax:414-271-1746
Practice Address - Street 1:735 N WATER STREET
Practice Address - Street 2:SUITE 826
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4104
Practice Address - Country:US
Practice Address - Phone:414-271-1770
Practice Address - Fax:414-271-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50004680151223G0001X
WIWI35000151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty