Riverside Practice, LLC
Dentist, Oral and Maxillofacial Surgery in Austin, TX. Organization (NPI-2).
NPI number1679062020
StatusActive
Last updated in NPPESMar 24, 2023
Details
- NPI
- 1679062020
- Entity type
- Organization (NPI-2)
- Legal business name
- Riverside Practice, LLC
- Organization subpart
- No
- Enumeration date
- May 1, 2018
- Certification date
- Mar 24, 2023
- Last updated
- Mar 24, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | – | – | Yes |
Practice location
2410 E Riverside Dr Ste H12Austin, TX 78741-3054
Phone 512-442-1224
Mailing address
12613 Scofield Farms DrAustin, TX 78727-4542
Phone 225-802-9534
Authorized official
Asha Patel
President
2258029534
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