Riverside Family Dental, P.A.
Clinic/Center, Dental in Anoka, MN. Organization (NPI-2).
NPI number1982308847
StatusActive
Last updated in NPPESMar 27, 2023
Details
- NPI
- 1982308847
- Entity type
- Organization (NPI-2)
- Legal business name
- Riverside Family Dental, P.A.
- Organization subpart
- No
- Enumeration date
- Mar 27, 2023
- Certification date
- Mar 27, 2023
- Last updated
- Mar 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Riverside Family Dental, P.A. (Doing Business As)
Practice location
2006 1st Ave Ste 202Anoka, MN 55303-2255
Phone 763-427-7930 · Fax 763-427-7537
Mailing address
2006 1st Ave Ste 202Anoka, MN 55303-2255
Phone 763-427-7930
Authorized official
Kamal M Fakhreddine
Owner/President
7634277930
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