Healthcare Provider Details

I. General information

NPI: 1285022533
Provider Name (Legal Business Name): RIVERDALE ORAL HEALTH & IMPLANT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W 239TH ST
BRONX NY
10463-1211
US

IV. Provider business mailing address

611 WEST 239TH STREET
BRONX NY
10463
US

V. Phone/Fax

Practice location:
  • Phone: 715-548-3353
  • Fax:
Mailing address:
  • Phone: 715-548-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: DR. SIDNEY ADLER
Title or Position: PARTNER
Credential:
Phone: 718-548-3353