| Riverside Practice, Llc | |
|
2410 E Riverside Dr Ste H12 Austin TX 78741-3054 | |
| (512) 442-1224 | |
| Not Available |
| Full Name | Riverside Practice, Llc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2410 E Riverside Dr Ste H12, Austin, Texas |
| Authorized Official Name and Position | Asha Patel (PRESIDENT) |
| Authorized Official Contact | 2258029534 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Practice, Llc 12613 Scofield Farms Dr Austin TX 78727-4542 Ph: (225) 802-9534 | Riverside Practice, Llc 2410 E Riverside Dr Ste H12 Austin TX 78741-3054 Ph: (512) 442-1224 |
| NPI Number | 1679062020 |
|---|---|
| Provider Enumeration Date | 05/01/2018 |
| Last Update Date | 03/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679062020 | NPI | - | NPPES |
| 195206120 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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