# RIVERSIDE DENTAL STUDIO, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255224739
- **Authorized official:** DR. MICHAEL DAVID MATTIACIO DDS (PRESIDENT)
- **Authorized official phone:** (315) 885-5885

## Contact information

- **Practice address:** 2 OSWEGO ST STE 200, BALDWINSVILLE, NY 13027-2550
- **Practice address phone:** (315) 638-2288
- **Practice address fax:** (315) 638-4132
- **Mailing address:** 2 OSWEGO ST STE 200, BALDWINSVILLE, NY 13027-2550
- **Mailing address phone:** (315) 638-2288
- **Mailing address fax:** (315) 638-4132

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/02/2025
- **Last updated:** 06/02/2025