Provider Demographics
NPI:1316300460
Name:RIVERSIDE FAMILY DENTAL CARE, INC
Entity type:Organization
Organization Name:RIVERSIDE FAMILY DENTAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:385-229-4222
Mailing Address - Street 1:1614 W 700 N
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116
Mailing Address - Country:US
Mailing Address - Phone:385-229-4222
Mailing Address - Fax:801-883-9276
Practice Address - Street 1:1614 W 700 N
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116
Practice Address - Country:US
Practice Address - Phone:385-229-4222
Practice Address - Fax:801-883-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4923760261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental