MEDICARE: ASSOCIATED RIVERBEND DENTISTS 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	122300000X	Dentist

General Provider Information

NPI Number	:	1568503902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED RIVERBEND DENTISTS PC

Provider Business Mailing Address
First Line	:	521 EAST MONROE STREET
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-2325
Country	:	US
Telephone Number	:	574-234-1700
Fax Number	:	574-287-6453

Provider Business Practice Location Address
First Line	:	521 EAST MONROE STREET
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-2325
Country	:	US
Telephone Number	:	574-234-1700
Fax Number	:	574-287-6453

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MR. GEORGE WASHINGTON SURGUY
Credential	:	DDS
Telephone Number	:	574-234-1700

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/22/2020

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