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Organization
RIVERSIDE DENTAL CENTER
Active
Organization
RIVERSIDE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD M DONNELLI DDS (OWNER)
(815) 877-4300
Entity
Organization
Contact information
Practice address
2028 E RIVERSIDE BLVD, SUITE 210, LOVES PARK, IL 61111-4804
(815) 877-4300
Mailing address
2028 E RIVERSIDE BLVD, SUITE 210, LOVES PARK, IL 61111-4804
(815) 877-4300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
08/05/2007
Last updated
08/05/2007
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