The River'S Edge Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

THE RIVER'S EDGE DENTAL

Practice address

1185 N Arizona Blvd
Coolidge, AZ 85128

Phone

(435) 518-3343

NPI assigned

Jul 17, 2019

Organization subpart

No

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

Authorized official

Name

Marvin Blane Jackson, DDS

Title

Owner / Dentist

Phone

(435) 637-2100

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563321600000",
    "number": "1265085567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 N ARIZONA BLVD",
            "city": "COOLIDGE",
            "state": "AZ",
            "postal_code": "85128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 N ARIZONA BLVD",
            "city": "COOLIDGE",
            "state": "AZ",
            "postal_code": "85128",
            "telephone_number": "435-518-3343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RIVER'S EDGE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-17",
        "last_updated": "2019-07-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "BLANE",
        "authorized_official_title_or_position": "OWNER / DENTIST",
        "authorized_official_telephone_number": "435-637-2100",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; 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.