The River'S Edge Dental
Dentist, General Practice in Coolidge, AZ. Organization (NPI-2).
NPI number1265085567
StatusActive
Last updated in NPPESJul 17, 2019
Details
- NPI
- 1265085567
- Entity type
- Organization (NPI-2)
- Legal business name
- The River'S Edge Dental
- Organization subpart
- No
- Enumeration date
- Jul 17, 2019
- Last updated
- Jul 17, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
1185 N Arizona BlvdCoolidge, AZ 85128
Phone 435-518-3343
Mailing address
1185 N Arizona BlvdCoolidge, AZ 85128
Authorized official
Marvin Blane Jackson
Owner / Dentist
4356372100
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