Provider Demographics
NPI:1316142714
Name:RIVERHILL DENTAL ASSOCIATES SC
Entity type:Organization
Organization Name:RIVERHILL DENTAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-421-1515
Mailing Address - Street 1:406 DALY AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4744
Mailing Address - Country:US
Mailing Address - Phone:715-421-1515
Mailing Address - Fax:715-423-8552
Practice Address - Street 1:406 DALY AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4744
Practice Address - Country:US
Practice Address - Phone:715-421-1515
Practice Address - Fax:715-423-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34321223G0001X
WI29581223G0001X
WI1070G1223G0001X
WI41111223G0001X
WI13891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty