MEDICARE: RIVERVIEW DENTAL CARE, P.C.

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	907429	VA

General Provider Information

NPI Number	:	1639575913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERVIEW DENTAL CARE, P.C.

Provider Business Mailing Address
First Line	:	4035 RIVERSIDE DR
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-5152
Country	:	US
Telephone Number	:	434-793-2045
Fax Number	:	434-793-8820

Provider Business Practice Location Address
First Line	:	4035 RIVERSIDE DR
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-5152
Country	:	US
Telephone Number	:	434-793-2045
Fax Number	:	434-793-8820

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN P SNOW
Credential	:	DDS
Telephone Number	:	434-793-2045

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/13/2014

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