Organization
RIVERSIDE DENTAL INVESTMENTS LLC
Active
Other names
Generations Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SARA J BAILEY (OFFICE MANAGER)
(815) 765-9900
Entity
Organization
Contact information
Practice address
13510 JULIE DR, POPLAR GROVE, IL 61065-7829
(815) 765-9900
(815) 765-9901
Mailing address
13510 JULIE DR, POPLAR GROVE, IL 61065-7829
(815) 765-9900
(815) 765-9901
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134353014
INDIVIDUAL NPI
IL
01
—
1356461255
INDIVIDUAL NPI
IL
Enumeration date
07/20/2021
Last updated
07/20/2021
Update your record
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