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General NPI Number Information
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NPI Number | 1922770494
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 194 MAIN ST STE 2R
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City | AMESBURY
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State | MA
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Zip | 01913-3609
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Country | US
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Telephone | 978-378-0408
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Fax |
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Provider Business Mailing Address
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Address Line | 194 MAIN ST STE 2R
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City | AMESBURY
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State | MA
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Zip | 01913-3609
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Country | US
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Telephone | 978-378-0408
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Fax |
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | DR. RACHEL ALYSSA COOK
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Credential | DDS
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Telephone | 989-284-5267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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