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RIVERSIDE PRACTICE LLC NPI 1679062020


NPI Information

NPI: 1679062020
Provider Name: RIVERSIDE PRACTICE, LLC
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
2410 E RIVERSIDE DR STE H12
AUSTIN, TX
ZIP 78741
Phone: (512) 442-1224
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RIVERSIDE PRACTICE, LLC is an oral and maxillofacial surgery dentist in Austin, TX. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. RIVERSIDE PRACTICE, LLC NPI is 1679062020. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2410 E RIVERSIDE DR STE H12
AUSTIN, TX
ZIP 78741-054
Phone: (512) 442-1224

The provider's authorized official is Asha Patel .
The authorized official title is President and has the following contact phone number (225) 802-9534.

The enumeration date for this NPI number is 5/1/2018 and was last updated on 3/24/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1195206120MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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