MEDICARE: RIVKA GOLDENHERSH 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	1223G0001X	General Practice Dentistry	2010025826	MO

General Provider Information

NPI Number	:	1932405792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIVKA GOLDENHERSH DMD

Provider Business Mailing Address
First Line	:	819 UNIVERSITY PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-5021
Country	:	US
Telephone Number	:	314-918-5921
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 UNIVERSITY PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-5021
Country	:	US
Telephone Number	:	314-918-5921
Fax Number	:

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

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	02/14/2019

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