Healthcare Provider Details

I. General information

NPI: 1811808389
Provider Name (Legal Business Name): RIVERSIDE FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23462-2822
US

IV. Provider business mailing address

367 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23462-2822
US

V. Phone/Fax

Practice location:
  • Phone: 757-497-2988
  • Fax: 757-497-5387
Mailing address:
  • Phone: 757-497-2988
  • Fax: 757-497-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: RITCHELLE SAN JUAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-497-2988