Healthcare Provider Details

I. General information

NPI: 1457666232
Provider Name (Legal Business Name): RIVERVIEW PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CANAL SHORE DR
LE CLAIRE IA
52753
US

IV. Provider business mailing address

1111 CANAL SHORE DR
LE CLAIRE IA
52753
US

V. Phone/Fax

Practice location:
  • Phone: 563-355-1034
  • Fax: 563-359-1824
Mailing address:
  • Phone: 563-355-1034
  • Fax: 563-359-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER C CANNON
Title or Position: PARTNER
Credential: DDS
Phone: 563-359-9165