Provider Demographics
NPI:1215147897
Name:RIVER ROAD DENTAL PC
Entity type:Organization
Organization Name:RIVER ROAD DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-840-0045
Mailing Address - Street 1:103 RIVER RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1016
Mailing Address - Country:US
Mailing Address - Phone:201-840-0045
Mailing Address - Fax:201-840-1095
Practice Address - Street 1:103 RIVER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1016
Practice Address - Country:US
Practice Address - Phone:201-840-0045
Practice Address - Fax:201-840-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02193600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty