# THE RIVER'S EDGE DENTAL

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

## Provider details

- **NPI number:** 1265085567
- **Authorized official:** MARVIN BLANE JACKSON DDS (OWNER / DENTIST)
- **Authorized official phone:** (435) 637-2100

## Contact information

- **Practice address:** 1185 N ARIZONA BLVD, COOLIDGE, AZ 85128
- **Practice address phone:** (435) 518-3343
- **Mailing address:** 1185 N ARIZONA BLVD, COOLIDGE, AZ 85128

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/17/2019
- **Last updated:** 07/17/2019