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General NPI Number Information
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NPI Number | 1972740249
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Entity Type | Organization
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Legal Business Name | RIVERSIDE DENTAL LLC
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 368 E RIVERSIDE DR BLDG #2
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City | ST GEORGE
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State | UT
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Zip | 84790-6896
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Country | US
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Telephone | 435-673-3363
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Fax |
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Provider Business Mailing Address
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Address Line | 368 E RIVERSIDE DR BLDG #2
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City | ST GEORGE
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State | UT
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Zip | 84790-6896
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Country | US
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Telephone | 435-673-3363
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DAVID R STEVENS
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Credential | DDS
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Telephone | 435-673-3363
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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 | 5929127-9923
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License Number State | UT
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