Organization
THE RIVER'S EDGE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN BLANE JACKSON DDS (OWNER / DENTIST)
(435) 637-2100
Entity
Organization
Contact information
Practice address
1185 N ARIZONA BLVD, COOLIDGE, AZ 85128
(435) 518-3343
Mailing address
1185 N ARIZONA BLVD, COOLIDGE, AZ 85128
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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