Healthcare Provider Details

I. General information

NPI: 1881699239
Provider Name (Legal Business Name): RIVERVIEW DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N SHIAWASSEE ST
CORUNNA MI
48817-1039
US

IV. Provider business mailing address

611 N SHIAWASSEE ST
CORUNNA MI
48817-1039
US

V. Phone/Fax

Practice location:
  • Phone: 989-743-4851
  • Fax: 989-743-3169
Mailing address:
  • Phone: 989-743-4851
  • Fax: 989-743-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11588
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13500
License Number StateMI

VIII. Authorized Official

Name: DR. PAUL R KUHLMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 989-743-4851