Provider Demographics
NPI:1588876759
Name:JAMES RIVER DENTISTRY, P.C.
Entity type:Organization
Organization Name:JAMES RIVER DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F W
Authorized Official - Last Name:CUDWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-947-2354
Mailing Address - Street 1:120 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1903
Mailing Address - Country:US
Mailing Address - Phone:701-947-2354
Mailing Address - Fax:701-947-2356
Practice Address - Street 1:120 1ST ST S
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1903
Practice Address - Country:US
Practice Address - Phone:701-947-2354
Practice Address - Fax:701-947-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41346Medicaid