Provider Demographics
NPI:1427349216
Name:RIVERSIDE DENTISTRY, LLC
Entity type:Organization
Organization Name:RIVERSIDE DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:309-797-2001
Mailing Address - Street 1:609 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-1450
Mailing Address - Country:US
Mailing Address - Phone:309-797-2001
Mailing Address - Fax:309-764-8236
Practice Address - Street 1:609 22ND ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1450
Practice Address - Country:US
Practice Address - Phone:309-797-2001
Practice Address - Fax:309-764-8236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190170341223G0001X
IL0190252871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty