Organization
RIVERSIDE FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARDY COSTA (ADMINISTRATOR)
(508) 728-5019
Entity
Organization
Contact information
Practice address
1445 WAMPANOAG TRL UNIT 209, RIVERSIDE, RI 02915-1019
(401) 433-2400
(401) 433-2403
Mailing address
1445 WAMPANOAG TRL UNIT 209, RIVERSIDE, RI 02915-1019
(401) 433-2400
(401) 433-2403
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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