Organization
RIVERSIDE PRACTICE, LLC
Active
Organization
RIVERSIDE PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ASHA PATEL DDS (PRESIDENT)
(225) 802-9534
Entity
Organization
Contact information
Practice address
2410 E RIVERSIDE DR STE H12, AUSTIN, TX 78741-3054
(512) 442-1224
Mailing address
12613 SCOFIELD FARMS DR, AUSTIN, TX 78727-4542
(225) 802-9534
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195206120
—
TX
Enumeration date
05/01/2018
Last updated
03/24/2023
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