Organization
RIVER VALLEY DENTAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN LAWRENCE TRI DDS (PRESIDENT)
(651) 437-1940
Entity
Organization
Contact information
Practice address
1260 N FRONTAGE RD, HASTINGS, MN 55033-2359
(651) 437-1940
(651) 437-9333
Mailing address
1260 N FRONTAGE RD, HASTINGS, MN 55033-2359
(651) 437-1940
(651) 437-9333
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10489
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4068165-00
—
MN
01
—
817972
UNITED CONCORDIA DENTAL INSURANCE
MN
Enumeration date
05/08/2008
Last updated
12/05/2014
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