| NPI | 1902534829 |
|---|---|
| Doing Business As | RIVERSIDE DENTAL |
| Entity Type | Organization |
| Authorized Contact | VICENTA REYES Credentialing Manager 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2022-08-09 |