Provider Demographics
NPI:1871794131
Name:RIVERSIDE FAMILY DENTAL
Entity type:Organization
Organization Name:RIVERSIDE FAMILY DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOSKUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-376-9975
Mailing Address - Street 1:547 SPINNING RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2157
Mailing Address - Country:US
Mailing Address - Phone:937-252-1463
Mailing Address - Fax:
Practice Address - Street 1:547 SPINNING RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-2157
Practice Address - Country:US
Practice Address - Phone:937-252-1463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH181861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty