Organization
RIVERGATE DENTAL GROUP
Active
Organization
RIVERGATE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODERICK VINCENT FRAZIER SR. DDS (OWNER)
(615) 851-1777
Entity
Organization
Contact information
Practice address
919 CONFERENCE DR, SUITE 5, GOODLETTSVILLE, TN 37072-1933
(615) 851-1777
(615) 851-1740
Mailing address
PO BOX 589, GOODLETTSVILLE, TN 37070-0589
(615) 851-1777
(615) 851-0877
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
DS005013
TN
Other
Enumeration date
03/31/2008
Last updated
03/31/2008
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