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General NPI Number Information
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NPI Number | 1487873527
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Entity Type | Organization
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Legal Business Name | RIVER FALLS DENTAL ASSOC LTD
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 650 SOUTH MAIN ST
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City | RIVER FALLS
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State | WI
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Zip | 54022
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Country | US
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Telephone | 715-425-6732
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Fax | 715-425-0101
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Provider Business Mailing Address
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Address Line | 650 SOUTH MAIN ST
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City | RIVER FALLS
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State | WI
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Zip | 54022
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Country | US
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Telephone | 715-425-6732
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Fax | 715-425-0101
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ZENOLA L MOORE
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Credential |
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Telephone | 715-425-6732
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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 | 3944
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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 | 5886015
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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 | 5001126
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License Number State | WI
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