Provider Demographics
NPI:1932890472
Name:RIVERTON HEIGHTS DENTAL, CORP.
Entity Type:Organization
Organization Name:RIVERTON HEIGHTS DENTAL, CORP.
Other - Org Name:RIVERTON HEIGHTS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT 1
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-781-5784
Mailing Address - Street 1:3693 W 13400 S STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6413
Mailing Address - Country:US
Mailing Address - Phone:801-781-5784
Mailing Address - Fax:385-483-0324
Practice Address - Street 1:3693 W 13400 S STE B
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6413
Practice Address - Country:US
Practice Address - Phone:801-781-5784
Practice Address - Fax:385-483-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1912113945Other1223G0001X - DENTIST - GENERAL PRACTICE
UT1104518687Other1223G0001X
UT1780890715Other1223G0001X - DENTIST - GENERAL PRACTICE