Healthcare Provider Details

I. General information

NPI: 1407030430
Provider Name (Legal Business Name): RIVERVIEW FAMILY DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 4TH STREET S #304
FARGO ND
58103-1937
US

IV. Provider business mailing address

100 4TH STREET S #304
FARGO ND
58103-1937
US

V. Phone/Fax

Practice location:
  • Phone: 701-235-6075
  • Fax: 701-239-0140
Mailing address:
  • Phone: 701-235-6075
  • Fax: 701-239-0140

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: WILLIAM G STEARNS
Title or Position: PRESIDENT-
Credential: DDS
Phone: 701-235-6075