| NPI | 1073204533 |
|---|---|
| Doing Business As | RIVERSIDE DENTAL |
| Entity Type | Organization |
| Authorized Contact | MARK JOHNSON Dentist 307-883-4222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-05-16 |