Healthcare Provider Details

I. General information

NPI: 1538089222
Provider Name (Legal Business Name): RIVERSIDE DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 RIVERSIDE DR
DANVILLE VA
24541-5537
US

IV. Provider business mailing address

4821 RIVERSIDE DR
DANVILLE VA
24541-5537
US

V. Phone/Fax

Practice location:
  • Phone: 434-820-0440
  • Fax:
Mailing address:
  • Phone: 434-822-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE A HAYES
Title or Position: DENTIST
Credential: DDS
Phone: 434-822-0440