Provider Demographics
NPI:1851118459
Name:RIVER TOWN DENTAL OF PELHAM
Entity type:Organization
Organization Name:RIVER TOWN DENTAL OF PELHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:INNABI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-462-7767
Mailing Address - Street 1:115 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1503
Mailing Address - Country:US
Mailing Address - Phone:914-738-2181
Mailing Address - Fax:
Practice Address - Street 1:115 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1503
Practice Address - Country:US
Practice Address - Phone:914-738-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty