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NPI Code Detail

MEDICARE: RIVERSIDE CENTER FOR FAMILY AND COSMETIC DENTITRY

MEDICARE: RIVERSIDE CENTER FOR FAMILY AND COSMETIC DENTITRY
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1538638002
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE CENTER FOR FAMILY AND COSMETIC DENTITRY
Provider Business Mailing Address
First Line : 2600 AMERICAN RD SE STE 230
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-1858
Country : US
Telephone Number : 505-922-6000
Fax Number : 505-922-6363
Provider Business Practice Location Address
First Line : 2600 AMERICAN RD SE STE 230
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-1858
Country : US
Telephone Number : 505-922-6000
Fax Number : 505-922-6363
Authorized Official
Title or Position : OWNER/DENTIST
Name : BARBARA LEWIS-HEYWOOD
Credential : DMD
Telephone Number : 505-922-6000
Provider Enumeration Date : 11/14/2018
Last Update Date : 11/14/2018

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Directions to “RIVERSIDE CENTER FOR FAMILY AND COSMETIC DENTITRY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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