Healthcare Provider Details

I. General information

NPI: 1619072220
Provider Name (Legal Business Name): NORTH RIVER DENTAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 US HIGHWAY 301 N
ELLENTON FL
34222-2010
US

IV. Provider business mailing address

3030 US HIGHWAY 301 N
ELLENTON FL
34222-2010
US

V. Phone/Fax

Practice location:
  • Phone: 941-722-0502
  • Fax: 941-722-3634
Mailing address:
  • Phone: 941-722-0502
  • Fax: 941-722-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD W STEINBERG
Title or Position: OWNER
Credential: DDS
Phone: 941-722-0502