River District Modern Dentistry PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

RIVER DISTRICT MODERN DENTISTRY PLLC

Practice address

21808 E Indiana Ave
Liberty Lake, WA 99019-4004

Phone

(509) 408-5080

Fax

(509) 461-0403

NPI assigned

Mar 15, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Mark Bradle, DMD

Title

Owner

Phone

(509) 408-5080

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1647302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1215685599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21808 E INDIANA AVE",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990194004",
            "telephone_number": "509-408-5080",
            "fax_number": "509-461-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21808 E INDIANA AVE",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990194004",
            "telephone_number": "509-408-5080",
            "fax_number": "509-461-0403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER DISTRICT MODERN DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-15",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BRADLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-408-5080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@riverdistrictmoderndentistry.com",
            "affiliation": "N",
            "endpointDescription": "office email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "21808 E Indiana Ave",
            "city": "Liberty Lake",
            "state": "WA",
            "country_code": "US",
            "postal_code": "990194004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Scott Ralph, D.D.S., M.S.
• Erin Ralston, RN
• Catrina Lillian Richards, LMT
• Nicole Elizabeth Rippee, MC 61510113
• River City Speech Therapy LLC
• Joy M Robinson
• Kyle P Robles, PA-C
• Rockwood Clinic PS (Rockwood Urgent Care-Liberty Lake)
• Rockwood Clinic PS (Rockwood Liberty Lake)
• Chantel Rose Rogge, LMT

• Dental Clinic/Center in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.