Provider Demographics
NPI:1699016618
Name:RIVER TOWN DENTAL, LLC
Entity type:Organization
Organization Name:RIVER TOWN DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE OPERATIO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-788-0030
Mailing Address - Street 1:3143 STATE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6964
Mailing Address - Country:US
Mailing Address - Phone:608-788-0030
Mailing Address - Fax:608-788-7881
Practice Address - Street 1:519 MCHUGH ROAD
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9256
Practice Address - Country:US
Practice Address - Phone:608-526-9300
Practice Address - Fax:608-526-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
WI50481223G0001X
WI52151223G0001X
WI62231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty