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NPI Code Detail

MEDICARE: RIVER NORTH FAMILY DENTISTRY PLLC

MEDICARE: RIVER NORTH FAMILY DENTISTRY PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1346750726
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVER NORTH FAMILY DENTISTRY PLLC
Provider Business Mailing Address
First Line : 2656 WALNUT ST
Second Line :
City : DENVER
State : CO
Zip : 80205-2231
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2656 WALNUT ST
Second Line :
City : DENVER
State : CO
Zip : 80205-2231
Country : US
Telephone Number : 720-381-7386
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : LINDSEY KELLY
Credential :
Telephone Number : 720-381-7386
Provider Enumeration Date : 10/11/2017
Last Update Date : 02/05/2018

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Directions to “RIVER NORTH FAMILY DENTISTRY PLLC ” Practice Location

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