Healthcare Provider Details

I. General information

NPI: 1194672469
Provider Name (Legal Business Name): RIVERGLOW DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N SHIAWASSEE ST
CORUNNA MI
48817-1039
US

IV. Provider business mailing address

3464 MCCLURE DR
TROY MI
48084-1508
US

V. Phone/Fax

Practice location:
  • Phone: 989-743-4851
  • Fax:
Mailing address:
  • Phone: 248-835-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RINOA JOONGSUN YOON
Title or Position: MEMBER
Credential: DDS
Phone: 248-835-5704