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General NPI Number Information
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NPI Number | 1811862196
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Entity Type | Organization
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Legal Business Name | RIVERSIDE DENTAL CENTER GPS PLLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2028 E RIVERSIDE BLVD STE 210
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City | LOVES PARK
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State | IL
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Zip | 61111-4800
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Country | US
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Telephone | 815-877-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 2028 E RIVERSIDE BLVD STE 210
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City | LOVES PARK
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State | IL
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Zip | 61111-4800
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | HUNTER SMITH
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Credential |
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Telephone | 815-877-4300
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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 |
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License Number State |
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