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General NPI Number Information
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NPI Number | 1104603513
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Entity Type | Organization
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Legal Business Name | RIVERSIDE DENTAL CARE LLC
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1805 E MAIN ST
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City | LITTLE CHUTE
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State | WI
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Zip | 54140-2455
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Country | US
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Telephone | 303-994-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 E MAIN ST
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City | LITTLE CHUTE
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State | WI
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Zip | 54140-2455
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Country | US
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Telephone | 920-423-9131
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Fax | 920-423-9132
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Authorized Official
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Title or Position | DENTIST
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Name | ELESE MCCLARIE
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Credential | DMD
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Telephone | 303-994-1456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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