Basic Information
| Provider Information | |||||||||
| NPI: | 1275172678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENTISTS OF RIVERTON, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17000 RED HILL AVE | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926145626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148458500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4531 W. PARTRIDGEHILL LANE | ||||||||
| Address2: | SUITE F-110 | ||||||||
| City: | RIVERTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014778864 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2020 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCAFFEE | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7148458500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.