| Organization Name: | RIVER PLACE DENTAL, INC |
| NPI Number: | 1215177555 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROLLYN PAUL LEE (OWNER) |
| Mailing Address: | 1030 River Place Drive Amery |
| State: | WI US |
| Postal Code: | 54001 |
| Phone Number: | 7152682103 |
| Fax Number: | 7152687729 |
| NPI Enumeration Date: | 02/26/2009 |
| NPI Last Update Date: | 07/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |