Provider Demographics
NPI:1558240481
Name:ANDREW J RIVERS, DMD PA
Entity type:Organization
Organization Name:ANDREW J RIVERS, DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-751-6289
Mailing Address - Street 1:781A VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2939
Mailing Address - Country:US
Mailing Address - Phone:336-751-6289
Mailing Address - Fax:
Practice Address - Street 1:781A VALLEY RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2939
Practice Address - Country:US
Practice Address - Phone:336-751-6289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty