Provider Demographics
NPI:1104195346
Name:RIVERBEND FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:RIVERBEND FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-547-5471
Mailing Address - Street 1:819 RIVER BEND DR STE A
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-2556
Mailing Address - Country:US
Mailing Address - Phone:256-547-5471
Mailing Address - Fax:256-546-0564
Practice Address - Street 1:819 RIVER BEND DR STE A
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-2556
Practice Address - Country:US
Practice Address - Phone:256-547-5471
Practice Address - Fax:256-546-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5859 C1122300000X
AL3057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty