Provider Demographics
NPI:1427128891
Name:NORTH RIVERS DENTAL ASSOC INC
Entity type:Organization
Organization Name:NORTH RIVERS DENTAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:L
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:CATES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-553-7827
Mailing Address - Street 1:2070 NORTHBROOK BLVD
Mailing Address - Street 2:SUITE 12A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-553-7827
Mailing Address - Fax:843-797-2559
Practice Address - Street 1:2070 NORTHBROOK BLVD
Practice Address - Street 2:SUITE 12A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-553-7827
Practice Address - Fax:843-797-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00823911OtherUNITED CONCORDIA