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General NPI Number Information
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NPI Number | 1932565504
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Entity Type | Organization
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Legal Business Name | RIVERHEART FAMILY DENTISTRY
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 8618 MEXICO RD
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City | O FALLON
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State | MO
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Zip | 63366-7507
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Country | US
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Telephone | 636-205-4045
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Fax |
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Provider Business Mailing Address
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Address Line | 8618 MEXICO RD
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City | O FALLON
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State | MO
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Zip | 63366-7507
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Country | US
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Telephone | 636-205-4045
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. TRAVIS SCHWARZ
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Credential | D.M.D.
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Telephone | 618-830-0958
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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 | 2011030941
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License Number State | MO
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