# MY RIVERTOWN DENTIST LLC

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

## Provider details

- **NPI number:** 1477176253
- **Authorized official:** ASHLEY LEE (OWNER)
- **Authorized official phone:** (812) 273-2388

## Contact information

- **Practice address:** 2513 MICHIGAN RD, MADISON, IN 47250-2422
- **Practice address phone:** (812) 273-2388
- **Mailing address:** 2513 MICHIGAN RD, MADISON, IN 47250-2422
- **Mailing address phone:** (812) 273-2388

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 05/27/2020
- **Last updated:** 07/08/2020