# EAST RIVER ROAD DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Riverside Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902534829
- **Authorized official:** VICENTA REYES (CREDENTIALING MANAGER)
- **Authorized official phone:** (972) 869-3789

## Contact information

- **Practice address:** 1640 E RIVER RD STE 112, TUCSON, AZ 85718-7645
- **Practice address phone:** (520) 299-4470
- **Mailing address:** 1640 E RIVER RD STE 112, TUCSON, AZ 85718-7645
- **Mailing address phone:** (520) 299-4470

## Taxonomy

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

## Other

- **Enumeration date:** 08/09/2022
- **Last updated:** 08/09/2022