# PROHEALTH RIVERSIDE DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROHEALTH RIVERSIDE DENTAL, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1538621305
- **Legal business name:** PROHEALTH RIVERSIDE DENTAL, LLC
- **Authorized official:** NATALYA KOROBEYNYK (RCM)
- **Authorized official phone:** (516) 654-4400

## Contact information

- **Practice address:** 1400 HUDSON ST \# 2, HOBOKEN, NJ 07030-5686
- **Practice address phone:** (201) 740-2700
- **Mailing address:** 3333 NEW HYDE PARK RD STE 310, NEW HYDE PARK, NY 11042-1205
- **Mailing address phone:** (516) 654-4400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 04/02/2019
- **Last updated:** 02/21/2023