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General NPI Number Information
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NPI Number | 1780790295
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Entity Type | Organization
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Legal Business Name | RIVERWALK DENTISTRY SC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 735 N WATER STREET SUITE 826
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City | MILWAUKEE
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State | WI
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Zip | 53202-4104
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Country | US
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Telephone | 414-271-1770
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Fax | 414-271-1746
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Provider Business Mailing Address
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Address Line | 735 N WATER STREET SUITE 826
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City | MILWAUKEE
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State | WI
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Zip | 53202-4104
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Country | US
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Telephone | 414-271-1770
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Fax | 414-271-1746
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | DR. BRYAN GAPSON
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Credential | DDS
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Telephone | 414-271-1770
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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 | 5000468015
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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 | WI3500015
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License Number State | WI
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