Provider Demographics
NPI:1215137658
Name:RIVER ROCK FAMILY DENTAL, PA
Entity type:Organization
Organization Name:RIVER ROCK FAMILY DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:VALBUENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-424-4655
Mailing Address - Street 1:1100 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5004
Mailing Address - Country:US
Mailing Address - Phone:785-424-4655
Mailing Address - Fax:
Practice Address - Street 1:1100 E 23RD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5004
Practice Address - Country:US
Practice Address - Phone:785-424-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty