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Organization

RIVER WILLOW DENTAL CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARTIN BRUNWORTH DDS (OWNER DENTIST)
(636) 392-6797
Entity
Organization

Contact information

Practice address
2 WAINWRIGHT ST STE 210, WASHINGTON, MO 63090
(636) 392-6797
(636) 392-6792
Mailing address
2 WAINWRIGHT ST STE 210, WASHINGTON, MO 63090
(636) 392-6797
(636) 392-6792

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
261QD0000X
Dental Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500154903
MO
Enumeration date
03/13/2025
Last updated
12/17/2025
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