Organization
RIVERGATE VILLAGE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHAWN FOSTER (PRACTICE ADMIN/REGIONAL DIRECTOR OP)
(615) 498-4323
Entity
Organization
Contact information
Practice address
1570 GALLATIN PIKE N, MADISON, TN 37115-2124
(615) 865-6000
(615) 865-6069
Mailing address
1570 GALLATIN PIKE N, MADISON, TN 37115-2124
(615) 865-6000
(615) 865-6069
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8569
TN
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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