River Valley Dental, P.a.

Primary specialty

DentistTaxonomy code 122300000X

License

D10489 Issued in MN

Legal business name

RIVER VALLEY DENTAL, P.A.

Practice address

1260 N Frontage Rd
Hastings, MN 55033-2359

Phone

(651) 437-1940

Fax

(651) 437-9333

NPI assigned

May 8, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin Lawrence Tri, DDS

Title

President

Phone

(651) 437-1940

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417737600000",
    "number": "1083880108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 N FRONTAGE RD",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550332359",
            "telephone_number": "651-437-1940",
            "fax_number": "651-437-9333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 N FRONTAGE RD",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550332359",
            "telephone_number": "651-437-1940",
            "fax_number": "651-437-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY DENTAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2014-12-05",
        "status": "A",
        "authorized_official_last_name": "TRI",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-437-1940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D10489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4068165-00",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA DENTAL INSURANCE",
            "identifier": "817972",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Lynn Richardson, OTR
• David John Ries, M.D.
• Rise Up Recovery
• River Bluff Mental Health, LLC
• River Pines Dental PA
• River Valley Spinal Health Center, P.a.
• Rivertown Eye Care PA
• Kevin R. Roach, M.D.
• Mona S.I. Roach, M.D.
• Susan J. Roe, M.D.

• Dentist in Hastings, MN
• Providers in Hastings, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.