MEDICARE: DR. CHRISTOPHER MICHAEL RIVERS DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D13730	MN

General Provider Information

NPI Number	:	1447641295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER MICHAEL RIVERS DMD

Provider Business Mailing Address
First Line	:	1835 COUNTY ROAD C W STE 200
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-1353
Country	:	US
Telephone Number	:	651-760-3610
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 COUNTY ROAD C W STE 200
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-1353
Country	:	US
Telephone Number	:	651-760-3703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	11/01/2020

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