Organization Name: | RIVERBEND PEDIATRIC DENTISTRY, LLC |
NPI Number: | 1770988594 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ADAM MILES SNYDER (MANAGING MEMBER) |
Mailing Address: | 705 Kansas St Bethalto |
State: | IL US |
Postal Code: | 620101796 |
Phone Number: | 6185963725 |
Fax Number: | |
NPI Enumeration Date: | 10/23/2014 |
NPI Last Update Date: | 10/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 021002548 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |