=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619072220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH RIVER DENTAL GROUP, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3030 US HIGHWAY 301 N
-----------------------------------------------------
City | ELLENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34222-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-722-0502
-----------------------------------------------------
Fax | 941-722-3634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3030 US HIGHWAY 301 N
-----------------------------------------------------
City | ELLENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34222-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-722-0502
-----------------------------------------------------
Fax | 941-722-3634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RICHARD W STEINBERG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 941-722-0502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------