MEDICARE: RIVERSIDE DENTAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19-14419	IL

General Provider Information

NPI Number	:	1073667184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE DENTAL, PC

Provider Business Mailing Address
First Line	:	401 MAIN ST
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-1535
Country	:	US
Telephone Number	:	815-273-2212
Fax Number	:	815-273-2218

Provider Business Practice Location Address
First Line	:	401 MAIN ST
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-1535
Country	:	US
Telephone Number	:	815-273-2212
Fax Number	:	815-273-2218

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM J TONNE
Credential	:	DDS
Telephone Number	:	815-273-2212

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/22/2020

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Directions to “RIVERSIDE DENTAL, PC ” Practice Location

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