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General NPI Number Information
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NPI Number | 1285046383
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Entity Type | Organization
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Legal Business Name | RIVER VALLEY PEDIATRIC DENTAL SPECIALISTS
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 425 W PRAIRIE VIEW RD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3389
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Country | US
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Telephone | 715-726-1060
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Fax | 715-726-1066
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Provider Business Mailing Address
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Address Line | 425 W PRAIRIE VIEW RD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3389
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Country | US
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Telephone | 715-726-1060
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Fax | 715-726-1066
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Authorized Official
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Title or Position | DMD/OWNER
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Name | DR. RENA J CHRISTMAN
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Credential | DMD
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Telephone | 715-726-1060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6936
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License Number State | WI
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