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General NPI Number Information
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NPI Number | 1316142714
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Entity Type | Organization
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Legal Business Name | RIVERHILL DENTAL ASSOCIATES SC
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 406 DALY AVE
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-4744
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Country | US
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Telephone | 715-421-1515
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Fax | 715-423-8552
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Provider Business Mailing Address
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Address Line | 406 DALY AVE
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-4744
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Country | US
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Telephone | 715-421-1515
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Fax | 715-423-8552
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JOANN C LASKY
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Credential |
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Telephone | 715-421-1515
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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 | 2958
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1070G
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4111
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1389
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3432
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License Number State | WI
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