Provider Demographics
NPI:1194295964
Name:RIVKA GOLDENHERSH, D.M.D., LLC
Entity type:Organization
Organization Name:RIVKA GOLDENHERSH, D.M.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIVKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDENHERSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-918-5921
Mailing Address - Street 1:620A N MCKNIGHT RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-4911
Mailing Address - Country:US
Mailing Address - Phone:314-432-5988
Mailing Address - Fax:
Practice Address - Street 1:620A N MCKNIGHT RD STE 2A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-432-5988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty